The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion

Park, Yung; Ha, Joong Won; Lee, Yun Tae; Sung, Na Young

doi:10.1016/j.spinee.2011.01.023

Cited by 55 publications

(43 citation statements)

References 18 publications

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“…Our study demonstrated that minimally invasive transforaminal lumbar interbody fusion improved clinical scores in patients with spondylolisthesis and other lumbar degenerative diseases; that the improvements observed were greater than the minimal clinically important difference threshold [2,10], consistent with the standards of arthrodesis outcomes described in the literature [3,4,6,16,17,[19][20][21][22][23][24][25]; and that these improvements were maintained up to 5 years after surgery. Our study also illustrated a challenging learning curve for this procedure.…”

Section: Discussionsupporting

confidence: 82%

“…Multiple studies have reported favorable results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion [3,4,6,8,16,17,[20][21][22][23][24][25]. These studies described results from 6 to 49 months after surgery; however, to our knowledge, data at minimum 5-year followup have never been reported.…”

Section: Introductionmentioning

confidence: 93%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. Questions/purposes We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. Methods We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003)(2004)(2005)(2006)(2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. Results At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. Conclusions Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 93%

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Park

Lee

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Many surgeons believe that patients who achieve a radiographic solid fusion will exhibit a more positive clinical outcome than those with a non-union. However, there is no clear evidence that radiographic solid fusion is associated with better clinical outcome scores than radiographic non-union [29]. Tsutsumimoto et al [30] demonstrated that the union group achieved better clinical results than the non-union group at the 5-year and final follow-up although no significant difference was observed at the 1-and 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

et al. 2012

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Purpose Due to the disadvantages of iliac crest bone and the poor bone quality of autograft gained from decompression surgery, alternative filling materials for posterior lumbar interbody fusion cages have been developed. b-Tricalcium phosphate is widely used in cages. However, data regarding the fusion rate of b-TCP assessed by computer tomography are currently not available. Materials A prospective clinical trial involving 34 patients (56.7 years) was performed: 26 patients were treated with single-level, five patients double-level and three patients triple-level PLIF filled with b-TCP and bone marrow aspirate perfusion, and additional posterior pedicle screw fixation. Fusion was assessed by CT and X-rays 1 year after surgery using a validated fusion scale published previously. Functional status was evaluated with the visual analogue scale and the Oswestry Disability Index before and 1 year after surgery. Results Forty-five levels in 34 patients were evaluated by CT and X-ray with a follow-up period of at least 1 year. Clinically, the average ODI and VAS for leg and back scores improved significantly (P \ 0.001). CT assessment revealed solid fusion in 12 levels (26.67 %) and indeterminate fusion in 15 levels (34.09 %). Inadequate fusion (non-union) was detected in 17 levels (38.63 %). Conclusion The technique of PLIF using b-TCP yielded a good clinical outcome 1 year after surgery, however, a high rate of pseudoarthrosis was found in this series therefore, we do not recommend b-TCP as a bone graft substitute using the PLIF technique.

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“…Several studies have suggested that achievement solid fusion post-operatively is a significant predictor of positive long-term clinical outcomes [4][5][6][7]. However, these trends have not been corroborated by other groups; Park et al [5] question this premise, pointing to methodological flaws and reported contradictory results in their study. A secondary goal is to minimize interbody device subsidence, which is associated with an increased rate of fusion failure [8].…”

Section: Introductionmentioning

confidence: 94%

Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation

et al. 2015

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Clinical studies at this early stage demonstrate that Ti/PEEK implants are safe and efficacious, exhibiting similar fusion rates and clinical outcomes compared to the current standard PEEK. There is clinical evidence substantiating the improved radiographic fusion of Ti/PEEK, albeit the differences were not significant. This field is promising, gaining substantial popularity, and further clinical trials are needed in the future to establish Ti/PEEK cages as a mainstay of clinical practice.

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The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion

Cited by 55 publications

References 18 publications

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation

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