Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

Abstract

The treatment effects of topping-off technique were still controversial. This study compared all available data on postoperative clinical and radiographic outcomes of topping-off technique and posterior lumbar interbody fusion (PLIF). PubMed, EMBASE, and Cochrane were systematically reviewed. Variations included radiographical adjacent segment disease (RASD), clinical adjacent segment disease (CASD), global lumbar lordosis (GLL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, and complication rates. Sixteen studies, including 1372 cases, were selected for the analysis. Rates of proximal RASD (P=0.0004), distal RASD (P=0.03), postoperative VAS-B (P=0.0001), postoperative VAS-L (P=0.02), EBL (P=0.007), and duration of surgery (P=0.02) were significantly lower in topping-off group than those in PLIF group. Postoperative ODI after 3 years (P=0.04) in the topping-off group was significantly less than that in the PLIF group. There was no significant difference in the rates of CASD (P=0.06), postoperative GLL (P=0.14), postoperative ODI within 3 years (P=0.24), and postoperative JOA (P=0.70) and in reoperation rates (P=0.32) and complication rates (P=0.27) between topping-off group and PLIF. The results confirmed that topping-off technique could effectively prevent ASDs after lumbar internal fixation. However, this effect is effective in preventing RASD. Topping-off technique is more effective in improving the subjective feelings of patients rather than objective motor functions compared with PLIF. With the development of surgical techniques, both topping-off technique and PLIF are safe.

Comparison Between PE-TLIF and MIS-TLIF in the Treatment of Middle-Aged and Elderly Patients with Single-Level Lumbar Disc Herniation

“…The scores of VAS, ODI, and JOA are commonly used indexes to assess the lumbar functions recovery and the postoperative efficacy. 35 Our results indicated that, in both groups, a significant decrease was observed in the VAS and ODI scores, and an increase was found in JOA scores at different post-surgical time points. No statistically significant difference was found for VAS leg pain, ODI, and JOA scores between the two groups at any follow-up time point.…”

Biomechanical Investigation of Lumbar Interbody Fusion Supplemented with Topping-off Instrumentation Using Different Dynamic Stabilization Devices

“…By collecting and consulting the published clinical literature, 8–10 the current authors found that topping-off instrumentation is often used following PLIF. Therefore, the PLIF procedure with conventional pedicle-based titanium rod fixation system (representing rigid fusion) at L4–L5 was initially simulated and used as a comparison baseline in this biomechanical study.…”

“…Based on the biomechanical evidence for ASD after lumbar or lumbosacral fusion, [2][3][4] the topping-off technique, which combines rigid fusion with PDS devices such as PBDSS or ISP extended to adjacent levels, has been proposed to prevent hypermobility and overstress at the adjacent segment and thus decrease the incidence of ASD. 5,6,8 Several clinical studies have also demonstrated the effectiveness of topping-off instrumentation using PBDSS or ISP in ASD prevention. 9,10 However, biomechanical differences between the PBDSS-based and ISP-based topping-off instrumentations still remain unclear.…”

“…7 The PDS devices for topping-off instrumentation are generally classified into pedicle-based dynamic stabilization system (PBDSS), such as Bioflex, Dynesys, NFlex, and so on, and interspinous process spacer (ISP), such as Coflex, DIAM, Wallis, and so on. 8 The effectiveness of PBDSSbased or ISP-based topping-off devices in preventing ASD has been evaluated through clinical observations. For example, Chen et al 9 reported that compared with rigid fusion alone, the topping-off instrumentation using a Coflex ISP was associated with a lower incidence of ASD (26.1% in the fusion group vs 13.2% in the topping-off group).…”

Comparison of long-term outcomes of spinal fusion surgeries supplemented with “topping-off” implants in lumbar degenerative diseases: A systematic review and network meta-analysis

“…Numerous clinical trials and pairwise meta-analyses comparing various topping-off devices with spinal fusion surgery alone have been performed [ 13 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. However, because each study only includes one or two devices, integrating information on the relative efficacy of commonly used topping-off implants is difficult.…”