Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis

McAnany, Steven J.; Baird, Evan O.; Qureshi, Sheeraz A.; Hecht, Andrew C.; Heller, John G.; Anderson, Paul A.

doi:10.1097/brs.0000000000001638

Cited by 36 publications

(20 citation statements)

References 23 publications

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“…Autografts and allografts containing autologous bone marrow are routinely employed to stimulate osteogenesis either at the intervertebral space as in anterior lumbar interbody fusion (ALIF; Bohl et al, ) or at an ectopic site between two lumbar transverse processes bilaterally as in a posterolateral lumbar fusion (PLF; Liu, Wang, Qiu, Weng, & Yu, ). A variety of disorders may be treated with spinal fusion, including degenerative disc disease (DDD), spondylolisthesis, spinal stenosis, scoliosis, infections, spinal fractures and dystrophy, and various tumours (McAnany et al, ).…”

Section: Introductionmentioning

confidence: 99%

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits

Vukičević

Grgurević

Erjavec

et al. 2019

J Tissue Eng Regen Med

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In the present study, we describe autologous blood coagulum (ABC) as a physiological carrier for BMP6 to induce new bone formation. Recombinant human BMP6 (rhBMP6), dispersed within ABC and formed as an autologous bone graft substitute (ABGS), was evaluated either with or without allograft bone particles (ALLO) in rat subcutaneous implants and in a posterolateral lumbar fusion (PLF) model in rabbits. ABGS induced endochondral bone differentiation in rat subcutaneous implants. Coating ALLO by ABC significantly decreased the formation of multinucleated foreign body giant cells (FBGCs) in implants, as compared with ALLO alone. However, addition of rhBMP6 to ABC/ALLO induced a robust endochondral bone formation with little or no FBGCs in the implant. In rabbit PLF model, ABGS induced new bone formation uniformly within the implant resulting in a complete fusion when placed between two lumbar transverse processes in the posterolateral gutter with an optimum dose of 100-μg rhBMP6 per ml of ABC. ABGS containing ALLO also resulted in a fusion where the ALLO was replaced by the newly formed bone via creeping substitution. Our findings demonstrate for the first time that rhBMP6, with ABC as a carrier, induced a robust bone formation with a complete spinal fusion in a rabbit PLF model. RhBMP6 was effective at low doses with ABC serving as a physiological substratum providing a permissive environment by protecting against foreign body reaction elicited by ALLO. KEYWORDS allograft (ALLO), autologous blood coagulum (ABC), autologous bone graft substitute (ABGS), foreign body giant cells, posterolateral lumbar fusion (PLF), recombinant human BMP6 (rhBMP6)This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Introductionmentioning

confidence: 99%

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits

Vukičević

Grgurević

Erjavec

et al. 2019

J Tissue Eng Regen Med

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“…2 This is of particular interest, as there is no robust data to support clinical superiority of adding interbody devices to instrumented posterior fusion. 10,15,31,32 It might be that this is being driven by the rise in popularity of minimally invasive surgery (MIS) that requires the interbody space for a surface area for fusion. Unfortunately, we cannot determine the percent of cases that were done with MIS techniques using the data sets employed here.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 If performing fusion, instrumentation has been accepted as a way to increase fusion success. 9,10 Interbody techniques have been suggested as ways to increase fusion success, potentially improve alignment, and/or allow for grafting with minimally invasive techniques. 10 However, there is debate on which fusion technique is best.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Interbody techniques have been suggested as ways to increase fusion success, potentially improve alignment, and/or allow for grafting with minimally invasive techniques. 10 However, there is debate on which fusion technique is best. Arguments for uninstrumented fusion include similar long-term results with and without instrumentation, poor cost-effectiveness of instrumentation, and risk of implant-related issues.…”

Section: Introductionmentioning

confidence: 99%

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Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

et al. 2019

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Background: Surgical treatment for lumbar degenerative spondylolisthesis has been shown to provide better longterm outcomes than conservative treatment. However, there is variation in surgical approaches employed by surgeons. This study investigates current surgical practice patterns and compares perioperative outcomes of 3 common surgical treatments for this pathology.Methods: A survey was administered to surgeons who attended the Lumbar Spine Research Society (LSRS) meeting in 2014. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005 to 2014 to characterize the same responses. The 2 data sets were compared. Perioperative outcomes of those in the ACS-NSQIP posterior fusion subcohorts were characterized and compared.Results: Posterior surgical approaches utilized by surgeons who responded to the LSRS survey were similar to those captured by ACS-NSQIP where 72% of those with degenerative spondylolisthesis were fused. Of those that were fused, 8% had an uninstrumented posterior fusion, 33% had an instrumented posterior fusion, and 59% had an instrumented posterior fusion with interbody. On multivariate analysis, there was no difference in risk of postoperative adverse events, readmission, or length of stay between these 3 common types of fusion.Conclusions: Practice patterns for the posterior management of lumbar degenerative spondylolisthesis were similar between LSRS survey responses and ACS-NSQIP data. The ACS-NSQIP perioperative outcome measures assessed were similar regardless of surgical technique. These findings highlight that cost-benefit considerations and longer-term outcomes have to be the measures by which surgical technique is chosen for degenerative spondylolisthesis. Lumbar Spine

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“…McAnany et al conducted a meta-analysis of five prior studies, including 383 patients treated with a PLF and 268 treated with IBF [38]. It was concluded that there was no difference in rates of fusion, operative time, EBL, and ODI, SF-36, and VAS outcome measures between procedures.…”

Section: Interbody Fusionmentioning

confidence: 99%

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Samuel

Moore

Cunningham

2017

Curr Rev Musculoskelet Med

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There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

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Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis

Abstract: 3.

Cited by 36 publications

References 23 publications

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

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