Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation

Aoki, Yasuchika; Yamagata, Masatsune; Nakajima, Fumitake; Ikeda, Yoshikazu; Shimizu, Koh; Yoshihara, Masakazu; Iwasaki, Junichi; Toyone, Tomoaki; Nakagawa, Kōichi; Nakajima, Arata; Takahashi, Kazuhisa; Ohtori, Seiji

doi:10.3171/2010.3.spine09590

Cited by 104 publications

(101 citation statements)

References 17 publications

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“…Three studies assessed VAS for leg pain, which was not different between the two groups either (MD = −0.10, 95% CI = −0.20 to 0.01; P = 0.06) (Figure 2b). ODI scores were available in five trials [16], [19]–[22] where no significant difference was detected between the two groups (MD = 0.31, 95% CI = −0.66 to 1.27; P = 0.54) (Figure 2c). …”

Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

Liu

Wang

et al. 2014

PLoS ONE

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Study DesignMeta-analysis.BackgroundBilateral pedicle screw fixation (PS) after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS) lumbar interbody fusion for one-level degenerative lumbar spine disease.MethodsMEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2.ResultsSix studies (5 RCTs and 1 CCT) involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS) for leg pain, VAS for back pain, Oswestry disability index (ODI). Both fixation procedures had similar length of hospital stay (MD = 0.38, 95% CI = −0.83 to 1.58; P = 0.54). In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P = 0.002) and significantly longer operation time (P = 0.02) as compared with unilateral PS fixation.ConclusionsUnilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease.

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Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

Liu

Wang

et al. 2014

PLoS ONE

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“…13 Recent studies also reported that TLIF with unilateral pedicle screw fixation showed less stability than TLIF with bilateral screws, particularly on lateral bending and contralateral rotation. 1,5,21 Aoki et al have reported that cage migration occurred frequently in cases involving unilateral pedicle screw fixation and a diagonal single cage, and they recommended bilateral screw fixation with a dual cage for a preoperatively highly unstable segment. 1 In all cases of our series we used a diagonal bullet-shaped cage with asymmetrical positioning (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,21 Aoki et al have reported that cage migration occurred frequently in cases involving unilateral pedicle screw fixation and a diagonal single cage, and they recommended bilateral screw fixation with a dual cage for a preoperatively highly unstable segment. 1 In all cases of our series we used a diagonal bullet-shaped cage with asymmetrical positioning (Fig. 6D) for both unilateral and bilateral pedicle screw groups, and cage migration only occurred in the unilateral pedicle screw fixation group.…”

Section: Discussionmentioning

confidence: 99%

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Choi

Park²,

Kim³

et al. 2013

FOC

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Object Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF. Methods This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment. Results The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%). Conclusions Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.

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“…However, secondary mobilisation rates in long term, stress shielding, and ensuing failure are its most common complications. According to recent reports, cages appear to have solved neither mechanically nor biologically interbody spinal osteosynthesis either in spinal fracture treatment, in degenerative spine stabilisation, or after correction of deformity [3,36,60,61,65].…”

Section: Interbody Cagesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

192

132

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation

Cited by 104 publications

References 17 publications

A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Surgical treatment of spondylodiscitis. An update

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