Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

Keorochana, Gun; Setrkraising, Kitipong; Woratanarat, Patarawan; Arirachakaran, Alisara; Kongtharvonskul, Jatupon

doi:10.1007/s10143-016-0806-8

Cited by 48 publications

(40 citation statements)

References 103 publications

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“…One meta-analysis compared minimally invasive TLIF with LLIF and found that there were no differences in fusion or complication rates. However, it did find that minimally invasive TLIF patients had better Oswestry Disability Index (ODI) and visual analog scale (VAS) pain scores when compared with LLIF patients [28].…”

Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

2020

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Background Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height. Questions/Purposes We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine. Methods Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review. Results Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK–titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation. Conclusions All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.

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Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

2020

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“…Recent literature review weighted average mean of preoperative visual analogue scale (VAS) pain scores of 6.8, compared to a postoperative VAS score of 2.9 (p<0.0001) [ 25 ]. Neurological outcome in 91.7% of patients who were unchanged or improved following surgery was good compared to reported data[ 2,6,12,44 ]. 35 patients (48.6%) underwent previous surgery in the segment that underwent XLIF.…”

Section: Discussionmentioning

confidence: 98%

“…(30 patients), Paterakis et al [ 7 ](12 patients), Timothy et al [ 1 ] (14 patients), Attenello et al [ 49 ](22 patients), Tamburelli et al [ 27 ] (21 patients), Campbell et al [ 12 ](18 patients), Tessitore et al [ 50 ](20 patients), Blizzard et al [ 29 ] (11 patients), Lykissas et al [ 35 ](451 patient), Isaacs et al [ 51 ] (29 patients with XLIF). In lumbar interbody fusion, MIS-TLIF (minimally invasive transforaminal interbody fusion) had better ODI, VAS pain, and complication rate when compared to XLIF with direct and indirect meta-analysis methods;however, in terms of fusion rates, there were no differences between the two techniques[ 44 ].Radiological outcome showed similar results in patients with degenerative spinal canal stenosis and spondylodiscitis. Improvement of regional lordosis (increase of sagittal L1-S1 angle of 36.2⁰ preoperative vs. 38.09⁰ postoperative) showed consistence with previous studies[ 7,25,29,30 ].…”

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confidence: 96%

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

Pojskić

Saß

Völlger

et al. 2021

Bosn J of Basic Med Sci

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Extreme lateral interbody fusion (XLIF) has become the standard of minimally invasive lumbar segmental scoliosis treatment. Our objective is to determine the safety and efficacy of XLIF in spinal canal stenosis (SCS) and spondylodiscitis (SD). Patients treated with XLIF in our department between 2012 and 2018 were retrospectively analyzed. Patient records with clinical and radiographical parameters were evaluated. The patient cohort consists of 40 male and 32 female patients with a median age of 66.6 years. Forty-five patients had an SCS and 27 patients SD. The mean follow-up was 23 months. One level XLIF was performed in 49 patients, 2 levels in 15, 3 levels in 7 patients and 4 levels in 1 patient. All but one patient received an additional dorsal stabilization. The pain was present in all patients with a mean Visual Analogue Scale (VAS) score of 8.8 vs. postoperative VAS of 2.8 (p<0.05). Preoperative neurological deficits were found in 44 patients. Only 6 patients had a neurological deterioration, 45 patients improved, and 21 patients remained unchanged. One patient experienced a perioperative complication. Non-fusion occurred in 8 cases. There were no outcome differences regarding pain and radiological outcome between patients with SCS and SD as well as between patients with one level vs. multilevel surgery. Baseline characteristics and the radiological outcome did not differ between the two groups. Patients with SD had a higher rate of worsening of neurological deficits following surgery, a higher rate of non-fusion, and a longer hospital stay. Patients with spinal canal stenosis SCS had a longer surgery time and more frequent adjacent segment disease.

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“…5,6 Minimally invasive lateral lumbar interbody fusion (LLIF) is now considered to be a standard approach for degenerative lumbar disorders. [24][25][26] Nevertheless, LLIF has some limits that need to be disclosed: neuromoni- toring is strictly needed due to the nonnegligible risk for nerve root injuries; the procedure cannot be performed at L5-S1 due to the iliac crest projection; and it is burdened by an intrinsic morbidity because of the violation of the psoas muscle. The necessity for aborting this procedure during the psoas transgression, especially for a highly degenerated and rotated L4-5 segment, is also a commonly reported experience.…”

Section: Discussionmentioning

confidence: 99%

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

Miscusi

Trungu

Ricciardi

et al. 2020

Neurosurgical Focus

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OBJECTIVEOver the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5–S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5–S1 segment in a single cohort of patients.METHODSThis is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5–S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively.RESULTSThirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44–75 years). The mean follow-up was 33.1 months (range 13–48 months). The mean pre- and postoperative visual analog scale (7.9 ± 1.3 vs 2.4 ± 0.8, p < 0.05), Oswestry Disability Index (52.8 ± 14.4 vs 22.9 ± 6.0, p < 0.05), and SF-36 (37.3 ± 5.8 vs 69.8 ± 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5–S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence–lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis.CONCLUSIONSIn the present case series, ATP fusion for the L5–S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5–S1 conditions.

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Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

Cited by 48 publications

References 103 publications

Interbody Fusions in the Lumbar Spine: A Review

Interbody Fusions in the Lumbar Spine: A Review

Extreme lateral interbody fusion (XLIF) in a consecutive series of 72 patients

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

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