Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature

Shah, Manan; Kolb, Bradley; Yılmaz, Emre; Halalmeh, Dia R.; Moisi, Marc

doi:10.7759/cureus.5691

Cited by 15 publications

(13 citation statements)

References 24 publications

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“…Lumbar interbody fusion procedures are usually performed in patients with degenerative lumbar disease when conservative treatments fail to alleviate pain for prolonged period. Operative approaches to lumbar interbody fusion include posterior, transforaminal, anterior and more recently lateral transpsoas access [ 1 , 2 ]. Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure, which circumvents some of the challenges and morbidity risks of anterior or posterior lumbar interbody fusion techniques, while affords necessarily indirect decompression for the treatment of spinal canal stenosis and places interbody cage without manipulation of neural structure [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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Background This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations. Methods Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS). Results Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP. Conclusions The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

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Section: Introductionmentioning

confidence: 99%

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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“…Lumbar spinal canal stenosis (LSCS) mostly occurs in the elderly population usually with the symptoms of low back and leg pain, limb numbness, and intermittent claudication or both owing to nerve compression. [1][2][3] Some causative factors, including disk protrusion, the degeneration of the facet joint, and ligamentum flavum (LF) hypertrophy result in the development of LSCS. 4,5 Importantly, LF hypertrophy is considered as the most important factor and highly associated with the pathogenesis of LSCS.…”

Section: Introductionmentioning

confidence: 99%

Ligamentum flavum fibrosis and hypertrophy: Molecular pathways, cellular mechanisms, and future directions

et al. 2020

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Hypertrophy of ligamentum flavum (LF), along with disk protrusion and facet joints degeneration, is associated with the development of lumbar spinal canal stenosis (LSCS). Of note, LF hypertrophy is deemed as an important cause of LSCS. Histologically, fibrosis is proved to be the main pathology of LF hypertrophy. Despite the numerous studies explored the mechanisms of LF fibrosis at the molecular and cellular levels, the exact mechanism remains unknown. It is suggested that pathophysiologic stimuli such as mechanical stress, aging, obesity, and some diseases are the causative factors. Then, many cytokines and growth factors secreted by LF cells and its surrounding tissues play different roles in activating the fibrotic response. Here, we summarize the current status of detailed knowledge available regarding the causative factors, pathology, molecular and cellular mechanisms implicated in LF fibrosis and hypertrophy, also focusing on the possible avenues for anti-fibrotic strategies.

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“…When looking for differences between imaging classification groups in order to identify whether variables could influence their presentation, it was found that there was no relationship between sex, BMI, or SS by performing Fisher's exact test (p-0.88, p-0.26, and p-0.232, respectively) and the classification into four groups (1 to 4) of the venous anatomy ( Table 3 ) . A significant relationship was found between the magnitude of the intraoperative bleeding (p < 0.01) and the degree of classification on the BDV scale, finding decreasing intraoperative bleeding rates in ascending types of classification (3)(4), indicating a more favorable venous configuration. Likewise, when assessing intraoperative time and its possible link to classification, it was found that patients with lower classification values were prone to present a prolonged surgical time (p < 0.01).…”

Section: Perceived Surgical Difficulty and Berbeo Scale -Diaz -Vargasmentioning

confidence: 87%

Venous anatomy of the lumbar region applied to anterior lumbar interbody fusion (ALIF): Proposal of a new classification

Moreno

Diaz-Orduz

Berbeo-Calderón

2021

North American Spine Society Journal (NASSJ)

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Background: Anterior lumbar interbody fusion (ALIF) is a good alternative for the surgical treatment of lumbar degenerative disc disease. The primary vascular complications regarding this intervention involve the common iliac vein bifurcation complex (CIVC). Currently, no classification system allows defining which patients are more prone to these complications. We aimed to perform a retrospective study evaluating the anatomy of the common iliac CIVC at the L5-S1 disc proposing a novel classification system as it relates to the ALIF difficulty. Methods: 91 consecutive patients who underwent ALIF at the L5-S1 level were included. We categorize the CIVC at the L5-S1 disc space into four types according to the veins position along the disc space. The patient records were reviewed for demographic information, surgical characteristics, and complications. The surgical difficulty was rated at the end of the procedure. Results: 54% of the patients were women. The mean age was 52.5 ± 14.8 years. Mean surgical bleeding was 152 ml (range 20ml -3000 ml), and mean surgical time was 79 ± 13.3 minutes. Berbeo-Diaz-Vargas (BDV) classification type 4 was found in 43.9% of the patients. The surgical complexity was associated with the bleeding magnitude and surgical time spent (p < 0.01), not being related to the corporal mass index or sacral slope. Bleeding magnitude, surgical time, and surgical complexity were significantly related to the BDV classification system (p < 0.01). Weighted Cohen´s kappa index for the BDV scale was 0.89 (95% IC 0.822 -0.974). Conclusions: BDV scale is a reliable and reproducible tool for the classification of CIVC significantly related to a higher incidence of bleeding, prolonged operating time, and increased perceived difficulty by the surgeon.

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Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature

Cited by 15 publications

References 24 publications

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Ligamentum flavum fibrosis and hypertrophy: Molecular pathways, cellular mechanisms, and future directions

Venous anatomy of the lumbar region applied to anterior lumbar interbody fusion (ALIF): Proposal of a new classification

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