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1
Fukushima, Masayoshi, Nozomu Ohtomo, Michita Noma, Yudai Kumanomido, Hiroyuki Nakarai, Keiichiro Tozawa, Yuichi Yoshida et al. "Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study". Medicina 57, n. 2 (8 febbraio 2021): 150. http://dx.doi.org/10.3390/medicina57020150.
Testo completoAbstract (sommario):
Background and objectives: Minimally invasive surgery has become popular for posterior lumbar interbody fusion (PLIF). Microendoscope-assisted PLIF (ME-PLIF) utilizes a microendoscope within a tubular retractor for PLIF procedures; however, there are no published reports that compare Microendoscope-assisted to open PLIF. Here we compare the surgical and clinical outcomes of ME-PLIF with those of open PLIF. Materials and Methods: A total of 155 consecutive patients who underwent single-level PLIF were registered prospectively. Of the 149 patients with a complete set of preoperative data, 72 patients underwent ME-PLIF (ME-group), and 77 underwent open PLIF (open-group). Clinical and radiographic findings collected one year after surgery were compared. Results: Of the 149 patients, 57 patients in ME-group and 58 patients in the open-group were available. The ME-PLIF procedure required a significantly shorter operating time and involved less intraoperative blood loss. Three patients in both groups reported dural tears as intraoperative complications. Three patients in ME-group experienced postoperative complications, compared to two patients in the open-group. The fusion rate in ME-group at one year was lower than that in the open group (p = 0.06). The proportion of patients who were satisfied was significantly higher in the ME-group (p = 0.02). Conclusions: ME-PLIF was associated with equivalent post-surgical outcomes and significantly higher rates of patient satisfaction than the traditional open PLIF procedure. However, the fusion rate after ME-PLIF tended to be lower than that after the traditional open method.
2
Li, Liqiang, Yueju Liu, Peng Zhang, Tao Lei, Jie Li e Yong Shen. "Comparison of posterior lumbar interbody fusion with transforaminal lumbar interbody fusion for treatment of recurrent lumbar disc herniation: A retrospective study". Journal of International Medical Research 44, n. 6 (3 novembre 2016): 1424–29. http://dx.doi.org/10.1177/0300060516645419.
Testo completoAbstract (sommario):
Objective To compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF) for spinal fusion in patients previously treated by discectomy. Methods This retrospective study evaluated pre- and postoperative neurological status via Japan Orthopaedic Association (JOA) score. Surgical outcome was based on recovery rate percentage (RR%). Adverse event data were reviewed. Results Both PLIF ( n = 26) and TLIF ( n = 25) significantly improved neurological status. There were no significant between-group differences in postoperative JOA score, RR% or surgical outcome. Overall, 92.3% patients in the PLIF group and 84% in the TLIF group had an excellent or good outcome (RR ≥ 65%). No patient had a poor outcome (RR < 50%). There were six cases of dural tear in the PLIF group and two in the TLIF group. Conclusions PLIF and TLIF provided good outcomes for recurrent lumbar disc herniation. TLIF may be preferred because of its shorter operative time and fewer procedure-related complications than PLIF.
3
Yoo, Sun-Joon, Kyung-Hyun Kim, Dong-Kyu Chin, Keun-Su Kim, Yong-Eun Cho e Jeong-Yoon Park. "Minimally Invasive versus Conventional Lumbar Interbody Fusion at L5–S1: A Retrospective Comparative Study". Journal of Minimally Invasive Spine Surgery and Technique 7, n. 1 (28 aprile 2022): 37–45. http://dx.doi.org/10.21182/jmisst.2022.00472.
Testo completoAbstract (sommario):
Objective: This study aimed to evaluate the radiologic and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and conventional posterior lumbar interbody fusion (PLIF) at the L5–S1.Methods: We retrospectively reviewed patients who underwent posterior lumbar fusion (MIS-TLIF and PLIF) at only the L5–S1 and were followed up for more than 12 months. Age, sex, body mass index (BMI), bone mineral density (BMD), diagnosis, comorbid conditions, fusion rate, perioperative results, and pre- and postoperative radiographic parameters at the L5–S1 level, pelvic parameters and degree of spondylolisthesis, and clinical results were analyzed.Results: A total of 102 patients (46 male, 56 female) with a mean age of 57.1 years were evaluated. Fifty and fifty-two patients underwent MIS-TLIF and PLIF surgeries, respectively. Radiologic parameters increased from their preoperative measures at the last follow-up study; similarly, there were no intergroup differences. The fusion rates in the MIS-TLIF and PLIF groups were 86% and 82.7%, respectively. The subsidence rates in the MIS-TLIF and PLIF groups were 6% and 3.8%, respectively. There was no intergroup difference in terms of fusion rate and subsidence. Clinical outcomes also gradually improved after surgery in both groups without intergroup differences.Conclusion: In L5–S1 posterior spinal surgery, there was no significant difference between MIS-TLIF and conventional PLIF. Considering the operation time and estimated blood loss, MIS-TLIF is more effective than PLIF surgery in terms of postoperative health care and economics.
4
Nomoto, Edward K., Guy R. Fogel, Alexandre Rasouli, Justin V. Bundy e Alexander W. Turner. "Biomechanical Analysis of Cortical Versus Pedicle Screw Fixation Stability in TLIF, PLIF, and XLIF Applications". Global Spine Journal 9, n. 2 (31 luglio 2018): 162–68. http://dx.doi.org/10.1177/2192568218779991.
Testo completoAbstract (sommario):
Study Design: Cadaveric biomechanical study. Objectives: Medial-to-lateral trajectory cortical screws are of clinical interest due to the ability to place them through a less disruptive, medialized exposure compared with conventional pedicle screws. In this study, cortical and pedicle screw trajectory stability was investigated in single-level transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and extreme lateral interbody fusion (XLIF) constructs. Methods: Eight lumbar spinal units were used for each interbody/screw trajectory combination. The following constructs were tested: TLIF + unilateral facetectomy (UF) + bilateral pedicle screws (BPS), TLIF + UF + bilateral cortical screws (BCS), PLIF + medial facetectomy (MF) + BPS, PLIF + bilateral facetectomy (BF) + BPS, PLIF + MF + BCS, PLIF + BF + BCS, XLIF + BPS, XLIF + BCS, and XLIF + bilateral laminotomy + BCS. Range of motion (ROM) in flexion-extension, lateral bending, and axial rotation was assessed using pure moments. Results: All instrumented constructs were significantly more rigid than intact ( P < .05) in all test directions except TLIF + UF + BCS, PLIF + MF + BCS, and PLIF + BF + BCS in axial rotation. In general, XLIF and PLIF + MF constructs were more rigid (lowest ROM) than TLIF + UF and PLIF + BF constructs. In the presence of substantial iatrogenic destabilization (TLIF + UF and PLIF + BF), cortical screw constructs tended to be less rigid (higher ROM) than the same pedicle screw constructs in lateral bending and axial rotation; however, no statistically significant differences were found when comparing pedicle and cortical fixation for the same interbody procedures. Conclusions: Both cortical and pedicle trajectory screw fixation provided stability to the 1-level interbody constructs. Constructs with the least iatrogenic destabilization were most rigid. The more destabilized constructs showed less lateral bending and axial rotation rigidity with cortical screws compared with pedicle screws. Further investigation is warranted to understand the clinical implications of differences between constructs.
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Okuda, Shinya, Takenori Oda, Ryoji Yamasaki, Takafumi Maeno e Motoki Iwasaki. "Repeated adjacent-segment degeneration after posterior lumbar interbody fusion". Journal of Neurosurgery: Spine 20, n. 5 (maggio 2014): 538–41. http://dx.doi.org/10.3171/2014.2.spine13800.
Testo completoAbstract (sommario):
One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4–5. At the second operation, L3–4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2–3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.
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El-Ghandour, Nasser, Mohamed Sawan, Atul Goel, Ahmed Assem Abdelkhalek, Ahmad M. Abdelmotleb, Taher Ali, Mohamed S. Abdel Aziz e Mohamed A. R. Soliman. "A Prospective Randomized Study of the Safety and Efficacy of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis: A Cost utility from a Lower-middle-income Country Perspective and Review of Literature". Open Access Macedonian Journal of Medical Sciences 9, B (3 agosto 2021): 636–45. http://dx.doi.org/10.3889/oamjms.2021.6569.
Testo completoAbstract (sommario):
BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials. AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes. METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations. RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed improvement in the TLIF group more than the PLIF group but with no significant difference. The mean operative time was significantly longer in the PLIF (p < 0.05), also, the blood loss was significantly less in the TLIF (p < 0.001). The complications frequency did not show any statistical significance between both groups and no significant difference in the patient’s post-operative patient satisfaction (p = 0.6). The mean hospital stay was non-significantly longer in the PLIF (p = 0.7). At 12-month follow-up, 93.3% of the TLIF patients were fused versus 86.7% of the PLIF (p = 0.5). The total cost of the TLIF was significantly less (p < 0.001). CONCLUSION: Both PLIF and TLIF could achieve similar fusion rates and clinical satisfaction in the management of lumbar spondylolisthesis. The TLIF group was significantly better in terms of financial burden, operative time, and blood loss.
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Mukai, Yoshihiro, Shota Takenaka, Noboru Hosono, Toshitada Miwa e Takeshi Fuji. "Intramuscular pressure of the multifidus muscle and low-back pain after posterior lumbar interbody fusion: comparison of mini-open and conventional approaches". Journal of Neurosurgery: Spine 19, n. 6 (dicembre 2013): 651–57. http://dx.doi.org/10.3171/2013.8.spine13183.
Testo completoAbstract (sommario):
Object This randomized study was designed to elucidate the time course of the perioperative development of intramuscular multifidus muscle pressure after posterior lumbar interbody fusion (PLIF) and to investigate whether the route of pedicle screw insertion affects this pressure and resultant low-back pain. Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, those studies examined intramuscular pressure generated by the muscle retractors during surgery. No study has investigated the intramuscular pressure after PLIF. Methods Forty patients with L4–5 degenerative spondylolisthesis were randomly assigned to undergo either the mini-open PLIF procedure with pedicle screw insertion between the multifidus and longissimus muscles (n = 20) or the conventional PLIF procedure via a midline approach only (n = 20). Intramuscular pressure was measured 5 times (at 30 minutes and at 6, 12, 24, and 48 hours after surgery) with an intraoperatively installed sensor. Concurrently, the FACES Pain Rating Scale score for low-back pain and the total dose of postoperative analgesics were recorded. Results With the patients in the supine position, for both groups the mean pressure values were consistently 40–50 mm Hg, which exceeded the critical capillary pressure of the muscle. With the patients in the lateral decubitus position, the pressure decreased over time (from 14 to 9 mm Hg in the mini-open group and from 20 to 10 mm Hg in the conventional group). Among patients in the mini-open group, the pressure was lower, but the difference was not statistically significant. Postoperative pain and postoperative analgesic dosages were also lower . Conclusions To the authors' knowledge, this is the first study to evaluate postoperative intramuscular pressure after PLIF. Although the results did not demonstrate a significant difference in the intramuscular pressure between the 2 types of PLIF, mini-open PLIF was associated with less pain after surgery. Clinical trial registration no.: UMIN000010069 (www.umin.ac.jp/ctr/index.htm).
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Zhang, Bin, Yuan Hu, Qingquan Kong, Pin Feng, Junlin Liu e Junsong Ma. "Comparison of Oblique Lumbar Interbody Fusion Combined with Posterior Decompression (OLIF-PD) and Posterior Lumbar Interbody Fusion (PLIF) in the Treatment of Adjacent Segmental Disease(ASD)". Journal of Personalized Medicine 13, n. 2 (19 febbraio 2023): 368. http://dx.doi.org/10.3390/jpm13020368.
Testo completoAbstract (sommario):
Background: An unintended consequence following lumbar fusion is the development of adjacent segment disease (ASD). Oblique lumbar interbody fusion combined with posterior decompression (OLIF-PD) is another feasible option for ASD, and there is no literature report on this combined surgical strategy. Methods: A retrospective analysis was performed on 18 ASD patients requiring direct decompression in our hospital between September 2017 and January 2022. Among them, eight patients underwent OLIF-PD revision and ten underwent PLIF revision. There were no significant differences in the baseline data between the two groups. The clinical outcomes and complications were compared between the two groups. Results: The operation time, operative blood loss and postoperative hospital stay in the OLIF-PD group were significantly lower than those in the PLIF group. The VAS of low back pain in the OLIF-PD group was significantly better than that in the PLIF group during the postoperative follow-up. The ODI at the last follow-up in the OLIF-PD group and the PLIF group were significantly relieved compared with those before operation. The excellent and good rate of the modified MacNab standard at the last follow-up was 87.5% in the OLIF-PD group and 70% in the PLIF group. There was a statistically significant difference in the incidence of complications between the two groups. Conclusion: For ASD requiring direct decompression after posterior lumbar fusion, compared with traditional PLIF revision surgery, OLIF-PD has a similar clinical effect, but has a reduced operation time, blood loss, hospital stay and complications. OLIF-PD may be an alternative revision strategy for ASD.
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Lee, Sanghoon, Dae-Woong Ham, Ohsang Kwon, Joon-Hee Park, Youngsang Yoon e Ho-Joong Kim. "Comparison of Fusion Rates among Various Demineralized Bone Matrices in Posterior Lumbar Interbody Fusion". Medicina 60, n. 2 (2 febbraio 2024): 265. http://dx.doi.org/10.3390/medicina60020265.
Testo completoAbstract (sommario):
Background and Objectives: Posterior lumbar interbody fusion (PLIF) plays a crucial role in addressing various spinal disorders. The success of PLIF is contingent upon achieving bone fusion, as failure can lead to adverse clinical outcomes. Demineralized bone matrix (DBM) has emerged as a promising solution for promoting fusion due to its unique combination of osteoinductive and osteoconductive properties. This study aims to compare the effectiveness of three distinct DBMs (Exfuse®, Bongener®, and Bonfuse®) in achieving fusion rates in PLIF surgery. Materials and Methods: A retrospective review was conducted on 236 consecutive patients undergoing PLIF between September 2016 and February 2019. Patients over 50 years old with degenerative lumbar disease, receiving DBM, and following up for more than 12 months after surgery were included. Fusion was evaluated using the Bridwell grading system. Bridwell grades 1 and 2 were defined as ‘fusion’, while grades 3 and 4 were considered ‘non-fusion.’ Clinical outcomes were assessed using visual analog scale (VAS) scores for pain, the Oswestry disability index (ODI), and the European quality of life-5 (EQ-5D). Results: Fusion rates were 88.3% for Exfuse, 94.3% for Bongener, and 87.7% for Bonfuse, with no significant differences. All groups exhibited significant improvement in clinical outcomes at 12 months after surgery, but no significant differences were observed among the three groups. Conclusions: There were no significant differences in fusion rates and clinical outcomes among Exfuse, Bongener, and Bonfuse in PLIF surgery.
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Sakaura, Hironobu, Toshitada Miwa, Tomoya Yamashita, Yusuke Kuroda e Tetsuo Ohwada. "Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study". Journal of Neurosurgery: Spine 25, n. 5 (novembre 2016): 591–95. http://dx.doi.org/10.3171/2016.3.spine151525.
Testo completoAbstract (sommario):
OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation. METHODS Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated. RESULTS The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p < 0.05). Solid spinal fusion was achieved in 84 patients from the CBT group (88.4%) and in 79 patients from the PS group (96.3%, p > 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p < 0.05). CONCLUSIONS PLIF with CBT screw fixation for DS provided comparable improvement of clinical symptoms with PLIF using traditional PS fixation. However, the successful fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.
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Sakaura, Hironobu, Daisuke Ikegami, Takahito Fujimori, Tsuyoshi Sugiura, Yoshihiro Mukai, Noboru Hosono e Takeshi Fuji. "Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation". Journal of Neurosurgery: Spine 32, n. 2 (febbraio 2020): 155–59. http://dx.doi.org/10.3171/2019.8.spine19631.
Testo completoAbstract (sommario):
OBJECTIVECortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.METHODSThe medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.RESULTSOne hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.CONCLUSIONSCBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.
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Aono, Hiroyuki, Shota Takenaka, Hidekazu Tobimatsu, Yukitaka Nagamoto, Masayuki Furuya, Tomoya Yamashita, Hiroyuki Ishiguro e Motoki Iwasaki. "Adjacent-segment disease after L3–4 posterior lumbar interbody fusion: does L3–4 fusion have cranial adjacent-segment degeneration similar to that after L4–5 fusion?" Journal of Neurosurgery: Spine 33, n. 4 (ottobre 2020): 455–60. http://dx.doi.org/10.3171/2020.3.spine20122.
Testo completoAbstract (sommario):
OBJECTIVEPosterior lumbar interbody fusion (PLIF) is a widely accepted procedure for degenerative lumbar diseases, and there have been many reports concerning adjacent-segment disease (ASD) after PLIF. In the reports of ASD in which the fusion level was limited to 1 segment, all reports describe ASD of the L3–4 segment after L4–5 PLIF. On the basis of these reports, it is thought that ASD mainly occurs at the cranial segment. However, no report has covered ASD after L3–4 PLIF. Therefore, the authors investigated ASD after L3–4 PLIF.METHODSIn conducting a retrospective case series analysis, the authors reviewed a surgical database providing details of all spine operations performed between 2006 and 2017 at a single institution. During that period, PLIF was performed to treat 632 consecutive patients with degenerative lumbar diseases. Of these patients, 71 were treated with L3–4 PLIF alone, and 67 who were monitored for at least 2 years (mean 5.8 years; follow-up rate 94%) after surgery were enrolled in this study. Radiological ASD (R-ASD), symptomatic ASD (S-ASD), and operative ASD (O-ASD) were evaluated. These types of ASD were defined as follows: R-ASD refers to radiological degeneration adjacent to the fusion segment as shown on plain radiographs; S-ASD is a symptomatic condition due to neurological deterioration at the adjacent-segment degeneration; and O-ASD refers to S-ASD requiring revision surgery.RESULTSAll patients had initial improvement of neurological symptoms after primary PLIF. R-ASD was observed in 32 (48%) of 67 patients. It occurred at the cranial segment in 12 patients and at the caudal segment in 24; R-ASD at both adjacent segments was observed in 4 patients. Thus, the occurrence of R-ASD was more significant in the caudal segment than in the cranial segment. S-ASD was observed in 10 patients (15%), occurring at the cranial segment in 3 patients and at the caudal segment in 7. O-ASD was observed in 6 patients (9%): at the cranial segment in 1 patient and at the caudal segment in 5. Thus, the rate of involvement of the caudal segment was 67% in R-ASD, 70% in S-ASD, and 83% in O-ASD.CONCLUSIONSThe incidences of R-ASD, S-ASD, and O-ASD were 48%, 15%, and 9%, respectively, after L3–4 PLIF for degenerative lumbar diseases. In contrast to ASD after L4–5 PLIF, ASD after L3–4 PLIF was more frequently observed at the caudal segment than at the cranial segment. In follow-up for patients with L3–4 PLIF, surgeons should pay attention to ASD in the caudal segment.
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Sun, Xiangyao, Zhaoxiong Chen, Siyuan Sun, Wei Wang, Tongtong Zhang, Chao Kong e Shibao Lu. "Dynamic Stabilization Adjacent to Fusion versus Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease: A Meta-Analysis". BioMed Research International 2020 (20 maggio 2020): 1–19. http://dx.doi.org/10.1155/2020/9309134.
Testo completoAbstract (sommario):
This study evaluated differences in outcome variables between dynamic stabilization adjacent to fusion (DATF) and posterior lumbar interbody fusion (PLIF) for the treatment of lumbar degenerative disease. A systematic review of PubMed, EMBASE, and Cochrane was performed. The variables of interest included clinical adjacent segment pathologies (CASPs), radiological adjacent segment pathologies (RASPs), lumbar lordosis (LL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery (DS), estimated blood loss (EBL), complications, and reoperation rate. Nine articles identified as meeting all of the inclusion criteria. DATF was better than PLIF in proximal RASP, CASP, and ODI during 3 months follow-up, VAS-L. However, no significant difference between DATF and PLIF was found in distal RASP, LL, JOA score, VAS-B, ODI after 3 months follow-up, complication rates, and reoperation rate. These further confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The differences between hybrid surgery and topping-off technique were located in DS and EBL in comparison with PLIF. Our study confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to the fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The difference between hybrid surgery and topping-off technique was not significant in treatment outcomes.
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Wu, Haiting, Qingjiang Pang e Guoqiang Jiang. "Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease". Journal of International Medical Research 45, n. 5 (29 giugno 2017): 1562–73. http://dx.doi.org/10.1177/0300060517708104.
Testo completoAbstract (sommario):
Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46–65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the stabilized segments with less influence on the proximal adjacent segment and may help to prevent the occurrence of adjacent segment degeneration. Dynesys is reliable for the treatment of multisegmental lumbar degenerative disease at the medium-term follow-up.
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Kudo, Yoshifumi, Ichiro Okano, Tomoaki Toyone, Akira Matsuoka, Hiroshi Maruyama, Ryo Yamamura, Koji Ishikawa et al. "Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression". Neurosurgical Focus 49, n. 3 (settembre 2020): E11. http://dx.doi.org/10.3171/2020.6.focus20361.
Testo completoAbstract (sommario):
OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.
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Wang, Wei, Xiangyao Sun, Tongtong Zhang, Siyuan Sun, Chao Kong e Shibao Lu. "Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis". BioMed Research International 2020 (13 gennaio 2020): 1–10. http://dx.doi.org/10.1155/2020/2953128.
Testo completoAbstract (sommario):
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.
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Caelers, Inge J. M. H., Suzanne L. de Kunder, Kim Rijkers, Wouter L. W. van Hemert, Rob A. de Bie, Silvia M. A. A. Evers e Henk van Santbrink. "Comparison of (Partial) economic evaluations of transforaminal lumbar interbody fusion (TLIF) versus Posterior lumbar interbody fusion (PLIF) in adults with lumbar spondylolisthesis: A systematic review". PLOS ONE 16, n. 2 (11 febbraio 2021): e0245963. http://dx.doi.org/10.1371/journal.pone.0245963.
Testo completoAbstract (sommario):
Introduction The demand for spinal fusion surgery has increased over the last decades. Health care providers should take costs and cost-effectiveness of these surgeries into account. Open transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are two widely used techniques for spinal fusion. Earlier research revealed that TLIF is associated with less blood loss, shorter surgical time and sometimes shorter length of hospital stay, while effectiveness of both techniques on back and/or leg pain are equal. Therefore, TLIF could result in lower costs and be more cost-effective than PLIF. This is the first systematic review comparing direct and indirect (partial) economic evaluations of TLIF with PLIF in adults with lumbar spondylolisthesis. Furthermore, methodological quality of included studies was assessed. Methods Searches were conducted in eight databases for reporting on eligibility criteria; TLIF or PLIF, lumbar spondylolisthesis or lumbar instability, and cost. Costs were converted to United States Dollars with reference year 2020. Study quality was assessed using the bias assessment tool of the Cochrane Handbook for Systematic Reviews of Interventions, the Level of Evidence guidelines of the Oxford Centre for Evidence-based Medicine and the Consensus Health Economic Criteria (CHEC) list. Results Of a total of 693 studies, 16 studies were included. Comparison of TLIF and PLIF could only be made indirectly, since no study compared TLIF and PLIF directly. There was a large heterogeneity in health care and societal perspective costs due to different in-, and exclusion criteria, baseline characteristics and the use of costs or charges in calculations. Health care perspective costs, calculated with hospital costs, ranged from $15,867-$43,217 in TLIF-studies and $32,662 in one PLIF-study. Calculated with hospital charges, it ranged from $8,964-$51,469 in TLIF-studies and $21,838-$93,609 in two PLIF-studies. Societal perspective costs and cost-effectiveness, only mentioned in TLIF-studies, ranged from $5,702/QALY-$48,538/QALY and $50,092/QALY-$90,977/QALY, respectively. Overall quality of studies was low. Conclusions This systematic review shows that TLIF and PLIF are expensive techniques. Moreover, firm conclusions about the preferable technique, based on (partial) economic evaluations, cannot be drawn due to limited studies and heterogeneity. Randomized prospective trials and full economical evaluations with direct TLIF and PLIF comparison are needed to obtain high levels of evidence. Furthermore, development of guidelines to perform adequate economic evaluations, specified for the field of interest, will be useful to minimize heterogeneity and maximize transferability of results. Trial registration Prospero-database registration number: CRD42020196869.
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Lu, Kang, Po-Chou Liliang, Hao-Kuang Wang, Cheng-Loong Liang, Jui-Sheng Chen, Tai-Been Chen, Kuo-Wei Wang e Han-Jung Chen. "Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation". Journal of Neurosurgery: Spine 23, n. 2 (agosto 2015): 190–96. http://dx.doi.org/10.3171/2014.12.spine14666.
Testo completoAbstract (sommario):
OBJECTMultilevel long-segment lumbar fusion poses a high risk for future development of adjacent-segment degeneration (ASD). Creating a dynamic transition zone with an interspinous process device (IPD) proximal to the fusion has recently been applied as a method to reduce the occurrence of ASD. The authors report their experience with the Device for Intervertebral Assisted Motion (DIAM) implanted proximal to multilevel posterior lumbar interbody fusion (PLIF) in reducing the development of proximal ASD.METHODSThis retrospective study reviewed 91 cases involving patients who underwent 2-level (L4–S1), 3-level (L3–S1), or 4-level (L2–S1) PLIF. In Group A (42 cases), the patients received PLIF only, while in Group B (49 cases), an interspinous process device, a DIAM implant, was put at the adjacent level proximal to the PLIF construct. Bone resection at the uppermost segment of the PLIF was equally limited in the 2 groups, with preservation of the upper portion of the spinous process/lamina and the attached supraspinous ligament. Outcome measures included a visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI) for functional impairment. Anteroposterior and lateral flexion/extension radiographs were used to evaluate the fusion status, presence and patterns of ASD, and mobility of the DIAM-implanted segment.RESULTSSolid interbody fusion without implant failure was observed in all cases. Radiographic ASD occurred in 20 (48%) of Group A cases and 3 (6%) of Group B cases (p < 0.001). Among the patients in whom ASD was identified, 9 in Group A and 3 in Group B were symptomatic; of these patients, 3 in Group A and 1 in Group B underwent a second surgery for severe symptomatic ASD. At 24 months after surgery, Group A patients fared worse than Group B, showing higher mean VAS and ODI scores due to symptoms related to ASD. At the final follow-up evaluations, as reoperations had been performed to treat symptomatic ASD in some patients, significant differences no longer existed between the 2 groups. In Group B, flexion/extension mobility at the DIAM-implanted segment was maintained in 35 patients and restricted or lost in 14 patients, 5 of whom had already lost segmental flexion/extension mobility before surgery. No patient in Group B developed ASD at the segment proximal to the DIAM implant.CONCLUSIONSProviding a dynamic transition zone with a DIAM implant placed immediately proximal to a multilevel PLIF construct was associated with a significant reduction in the occurrence of radiographic ASD, compared with PLIF alone. Given the relatively old age and more advanced degeneration in patients undergoing multilevel PLIF, this strategy appears to be effective in lowering the risk of clinical ASD and a second surgery subsequent to PLIF.
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Müslüman, Ahmet Murat, Adem Yılmaz, Tufan Cansever, Halit Çavuşoğlu, İbrahim Çolak, H. Ali Genç e Yunus Aydın. "Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes". Journal of Neurosurgery: Spine 14, n. 4 (aprile 2011): 488–96. http://dx.doi.org/10.3171/2010.11.spine10281.
Testo completoAbstract (sommario):
Object The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures. Methods Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically. Results The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3–4 (5 patients, 20%); L4–5 (14, 56%); and L5–S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3–4 (4 patients, 16%); L4–5 (13, 52%); and L5–S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group. Conclusions Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.
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Khoo, Larry T., Sylvain Palmer, Daniel T. Laich e Richard G. Fessler. "Minimally Invasive Percutaneous Posterior Lumbar Interbody Fusion". Neurosurgery 51, suppl_2 (1 novembre 2002): S2–166—S2–181. http://dx.doi.org/10.1097/00006123-200211002-00023.
Testo completoAbstract (sommario):
Abstract OBJECTIVE The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF). METHODS The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, Cobb angle, and foraminal height and volume. Using the METRx and MD spinal access systems (Medtronic Sofamor Danek, Memphis, TN), bilateral laminotomies were performed using a hybrid of microsurgical and microendoscopic techniques. The intervertebral disc spaces were then distracted and prepared with the Tangent (Medtronic Sofamor Danek) interbody instruments. Either a 10 or 12 by 22 mm interbody graft was then placed. Using the Sextant (Medtronic Sofamor Danek) system, percutaneous pedicle screw-rod fixation of the motion segment was completed. We then applied MIP-PLIF in three patients. RESULTS For segments with preoperative intervertebral/foraminal height loss, MIP-PLIF was effective in restoring both heights in all cases. The amount of improvement (9.7 to 38% disc height increase; 7.7 to 29.9% foraminal height increase) varied directly with the size of the graft used and the original degree of disc and foraminal height loss. Segmental lordosis improved by 29% on average. Graft and screw placement was accurate in the cadavers, except for a single Grade 1 screw violation of one pedicle. The average operative time was 3.5 hours per level. In our three clinical cases, the MIP-PLIF procedure required a mean of 5.4 hours, estimated blood loss was 185 ml, and inpatient stay was 2.8 days, with no intravenous narcotic use after 2 days in any of the patients. All screw and graft placements were confirmed. CONCLUSION A complete PLIF procedure can be safely and effectively performed using minimally invasive techniques, thereby potentially reducing the pain and morbidity associated with standard open surgery. Prospective, randomized outcome studies will be required to validate the efficacy of this exciting new surgical technique.
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Goodwin, Kelly, Emin Aghayev, Hans-Joachim Riesner, Ralph Greiner-Perth e Kathrin Bieri. "Dynamic Posterior Stabilization versus Posterior Lumbar Intervertebral Fusion: A Matched Cohort Study Based on the Spine Tango Registry". Journal of Neurological Surgery Part A: Central European Neurosurgery 79, n. 03 (18 gennaio 2018): 224–30. http://dx.doi.org/10.1055/s-0037-1615264.
Testo completoAbstract (sommario):
Purpose The primary aim of dynamic stabilization is to stabilize the spine and preserve function without overstressing adjacent segments, which is a potential risk of fusion surgery. However, direct comparative analyses of the two approaches are still limited, and little is known about the association of patient-reported outcomes with these treatment options. Objective To compare the clinical outcomes of dynamic posterior stabilization using the DSS Stabilization System (Paradigm Spine, LLC, New York, New York, United States) versus posterior lumbar intervertebral fusion (PLIF) based on data from a spine registry. We hypothesized that patient-reported outcomes of DSS are not inferior to those of PLIF. Methods We identified 202 DSS and 269 PLIF patients with lumbar degenerative disease with a minimum 2-year follow-up. A 1:1 propensity score–based matching was applied to balance the groups for various patient characteristics. The primary outcome was the change in the patient-reported Core Outcome Measures Index (COMI; a 0–10 scale) score. Results The matching resulted in 77 DSS-PLIF pairs (mean age: 67 years; average COMI follow-up: 3.3 years) without residual significant differences in baseline characteristics. The groups showed no difference in improved COMI score (p = 0.69), as well as in back (p = 0.51) and leg pain relief (p = 0.56), blood loss (p = 0.12), and complications (p > 0.15). Fewer repeat surgeries occurred after DSS (p = 0.01). The number of repeat surgeries per 100 observed person-years was 0.8 and 2.9 in DSS and in PLIF patients, respectively. Furthermore, shorter surgery time (p < 0.001) and longer hospital stays (p = 0.03) were observed for DSS cases. Conclusion In a midterm perspective, DSS may be a viable alternative to PLIF because both therapies result in similar COMI score improvement. Advantages of DSS may be shorter duration of surgery and fewer repeat surgeries. However, more than half of DSS patients did not find a match with a PLIF patient, suggesting that the patient profiles may be different. Further multicenter studies are needed to better understand the most appropriate indication for each therapy.
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Barnes, Bryan, Gerald E. Rodts, Mark R. McLaughlin e Regis W. Haid. "Threaded cortical bone dowels for lumbar interbody fusion: over 1-year mean follow up in 28 patients". Journal of Neurosurgery: Spine 95, n. 1 (luglio 2001): 1–4. http://dx.doi.org/10.3171/spi.2001.95.1.0001.
Testo completoAbstract (sommario):
Object. The authors retrospectively reviewed a series of 35 patients with mechanical low-back or one- to two-level discogenic pain; the patients underwent lumbar interbody fusion in which threaded cortical bone dowels (TCBDs) were placed to treat degenerative disc disease. The purpose of the study was to delineate fusion rates and outcome data in this series of patients. Methods. The series was composed of 18 women and 17 men whose mean age was 46 years (range 17–76 years). There were nine active cigarette smokers. All patients presented with symptoms consistent with mechanical low-back or discogenic pain, and magnetic resonance imaging revealed degenerative changes related to disc collapse at one or two vertebral levels. For placement of the TCBDs, 23 patients underwent posterior lumbar interbody fusion (PLIF), whereas 12 patients underwent anterior lumbar interbody fusion (ALIF). In all except one patient undergoing PLIF, pedicle screw and rod constructs were used without posterolateral fusion. In all patients undergoing ALIF except one, TCBDs were used as stand-alone devices without supplemental fixation. At follow up the success of fusion was determined by static lumbar radiography and/or computerized tomography scanning. The degree of lumbar lordosis at the diseased level was measured immediately postoperatively and compared with that documented on follow-up radiological studies. Outcomes were assessed using a modified Prolo Scale. Excellent and good outcomes were considered satisfactory, and fair or poor outcomes were considered unsatisfactory. In 28 patients (eight ALIF and 20 PLIF) radiological and clinical follow-up data were considered adequate. The mean follow-up duration was 12.3 months. Overall satisfactory outcome was 60%; 70% satisfactory outcome was noted in PLIF patients and 38% in ALIF patients. Osseous fusion was present in 95% of the patients in the PLIF group and in 13% of those in the ALIF group. Complications included one L-5 nerve root injury and two postoperative wound infections, all in patients who underwent PLIF; in an ALIF patient lateral breakout of one implant occurred at 8 months postoperatively. Conclusions. Analysis of the mean 12.3 month follow-up data indicates that there is a dramatically higher fusion rate in PLIF compared with ALIF procedures when TCBDs are used. The authors believe that it is important to note that in all the PLIF procedures except one, supplemental pedicle screw/rod constructs were used, whereas in ALIF procedures no supplemental fixation was performed. The results thus suggest that TCBDs are best used in PLIF in conjunction with pedicle screw and rod constructs.
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Alobaidaan, Raed, Jeremiah R. Cohen, Elizabeth L. Lord, Zorica Buser, S. Tim Yoon, Jim A. Youssef, Jong-Beom Park, Darrel S. Brodke, Jeffrey C. Wang e Hans-Joerg Meisel. "Complication Rates in Posterior Lumbar Interbody Fusion (PLIF) Surgery With Human Bone Morphogenetic Protein 2: Medicare Population". Global Spine Journal 7, n. 8 (16 maggio 2017): 770–73. http://dx.doi.org/10.1177/2192568217696695.
Testo completoAbstract (sommario):
Study Design: Retrospective cohort study among Medicare beneficiaries who underwent posterior lumbar interbody fusion (PLIF) surgery. Objective: To identify the complication rates associated with the use of bone morphogenetic protein 2 (BMP2) in PLIF. Human BMP2 is commonly used in the “off-label” manner for various types of spine fusion procedures, including PLIF. However, recent studies have reported potential complications associated with the recombinant human BMP2 (rhBMP2) use in the posterior approach. Methods: Medicare records within the PearlDiver database were queried for patients undergoing PLIF procedure with and without rhBMP2 between 2005 and 2010. We evaluated complications within 1 year postoperatively. Chi-square was used to compare the complication rates between the 2 groups. Results: A total of 8609 patients underwent PLIF procedure with or without rhBMP2. Individual complication rates in the rhBMP2 group ranged from 0.45% to 7.68% compared with 0.65% to 10.99 in the non-rhBMP2 group. Complication rates for cardiac, pulmonary, lumbosacral neuritis, infection, wound, and urinary tract (include acute kidney failure and post-operative complications) were significantly lower in the rhBMP2 group ( P < .05). There was no difference in the rates of central nervous system complications or radiculitis between the 2 groups. Conclusion: Our data showed that the patients who received rhBMP2 had lower complication rates compared to the non-rhBMP2 group. However, use of rhBMP2 was associated with a higher rate of pseudarthrosis. We did not observe any difference in radiculitis and central nervous system complications between the groups.
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Lee, Ji-Ho, Jae Hyup Lee, Kang-Sup Yoon, Seung-Baik Kang e Chris H. Jo. "COMPARATIVE STUDY OF UNILATERAL AND BILATERAL CAGES WITH RESPECT TO CLINICAL OUTCOMES AND STABILITY IN INSTRUMENTED POSTERIOR LUMBAR INTERBODY FUSION". Neurosurgery 63, n. 1 (1 luglio 2008): 109–14. http://dx.doi.org/10.1227/01.neu.0000335077.62599.f0.
Testo completoAbstract (sommario):
ABSTRACT OBJECTIVE We sought to compare the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using unilateral or bilateral polyetheretherketone cages and pedicle screws. METHODS One hundred eighty-seven cases of degenerative spine that had been followed for at least 18 months were reviewed retrospectively. In 88 cases (147 levels), one cage was inserted, and in 99 cases (152 levels), two cages were inserted. Visual analog scale, Oswestry disability index, and functional rating indices were measured. Lumbar lordosis, lumbar scoliotic and fusion level scoliotic angles, and stable fixation were determined before surgery and 12 months postoperatively on standing x-rays. Amounts of intra- and postoperative blood loss, total quantities transfused, and operation times were also evaluated. RESULTS No significant differences were found between the two groups in terms of visual analog scale, Oswestry disability index, functional rating indices, lumbar lordosis, lumbar scoliotic angles, fusion level scoliotic angles, or fixation stabilities. However, the amounts of postoperative blood loss, total blood loss, and total transfusion for two-level PLIF using a unilateral cage were statistically smaller than those for two-level PLIF using bilateral cages. Times required for PLIF using a unilateral cage were also significantly shorter than those for PLIF using bilateral cages. CONCLUSION Unilateral cage and bilateral pedicle screw insertion may be a good alternative surgical option because it provides adequate alignment, balance, and mechanical stability in addition to reducing operative time, blood loss, and transfusion requirements.
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Yang, Zhuo, Jianjun Chang, Lin Sun, Chien-Min Chen e Haoyu Feng. "Comparing Oblique Lumbar Interbody Fusion with Lateral Screw Fixation and Transforaminal Full-Endoscopic Lumbar Discectomy (OLIF-TELD) and Posterior Lumbar Interbody Fusion (PLIF) for the Treatment of Adjacent Segment Disease". BioMed Research International 2020 (30 maggio 2020): 1–7. http://dx.doi.org/10.1155/2020/4610128.
Testo completoAbstract (sommario):
Background. A potential long-term complication of lumbar fusion is the development of adjacent segment disease (ASD), which may require surgical intervention and adversely affect outcomes. A high incidence of recurrent ASD was reported in patients who underwent the second (repeat) PLIF for symptomatic ASD. Herein, a feasible method, oblique lumbar interbody fusion combined with transforaminal endoscopic lumbar discectomy (OLIF-TELD) for dealing with adjacent lumbar disc herniation with upward or downward migration after lumbar spinal fusion, was proposed. Methods. A total of 19 patients who underwent revision surgery at ASD were consecutively enrolled. Clinical efficacy analysis included operative time, intraoperative bleeding, visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) score, and Japanese orthopaedic association (JOA) assessment treatment score. Results. Among them, 11 patients were treated in a new surgical strategy, which is OLIF-TELD, and 8 patients underwent PLIF. There was no statistically significant difference between the two groups in terms of age, gender, and preoperative scores of VAS, ODI, and JOA. The operative duration was shorter, and intraoperative bleeding was less in the OLIF-TELD group compared with the PLIF group. PLIF had the greatest blood loss, and the OLIF-TELD group had lower VAS scores than the PLIF group postoperatively. The symptoms of all patients improved postoperatively with statistical significance. Conclusion. OLIF with lateral screw fixation combined with TELD may be an alternative surgical method for the treatment of adjacent lumbar disc herniation with upward or downward migration after lumbar fusion surgery.
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Min, Jun-Hong, Jee-Soo Jang e Sang-Ho Lee. "Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis". Journal of Neurosurgery: Spine 7, n. 1 (luglio 2007): 21–26. http://dx.doi.org/10.3171/spi-07/07/021.
Testo completoAbstract (sommario):
Object The purpose of this study was to compare the imaging and clinical outcomes obtained in patients with lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF) or instrumented posterior LIF (PLIF), especially with regard to the development of adjacent-segment degeneration (ASD). Methods Forty-eight patients with preoperative spondylolisthesis and minimal ASD who underwent instrumented L4–5 fusion were divided into two groups according to the surgical approach. After ensuring the two groups' comparability, the following variables were evaluated: postoperative segmental and lumbar lordosis, postoperative percentage of vertebral slippage, reduction rate, incidence of ASD, and clinical outcomes. Results Adjacent-segment degeneration was found in 44.0% of the patients in the ALIF group and in 82.6% of those in the PLIF group (p = 0.008). Clinical success rates were 92.0 and 87.0% in the ALIF and PLIF groups, respectively. There were no statistically significant intergroup differences in the postoperative segmental and lumbar lordosis, postoperative percentage of slippage, reduction rate, Japanese Orthopaedic Association score, and success rate. Conclusions Both ALIF and PLIF can produce good outcomes in treating lumbar spondylolisthesis, but ALIF is more advantageous in preventing the development of ASD.
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HORIE, Ryuta, Akira ITO, Xue Lei ZHU, Makihito NISHIOKA e Tadao TAKENO. "Measurement of NO in a Coflow Diffusion Flame by PLIF." Transactions of the Japan Society of Mechanical Engineers Series B 65, n. 629 (1999): 62–70. http://dx.doi.org/10.1299/kikaib.65.62.
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Jiang, N., J. Bruzzese, R. Patton, J. Sutton, R. Yentsch, D. V. Gaitonde, W. R. Lempert et al. "NO PLIF imaging in the CUBRC 48-inch shock tunnel". Experiments in Fluids 53, n. 6 (15 settembre 2012): 1637–46. http://dx.doi.org/10.1007/s00348-012-1381-6.
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Matsumoto, Tomiya, Shinya Okuda, Yukitaka Nagamoto, Tsuyoshi Sugiura, Yoshifumi Takahashi e Motoki Iwasaki. "Effects of Concomitant Decompression Adjacent to a Posterior Lumbar Interbody Fusion Segment on Clinical and Radiologic Outcomes: Comparative Analysis 5 Years After Surgery". Global Spine Journal 9, n. 5 (8 ottobre 2018): 505–11. http://dx.doi.org/10.1177/2192568218803324.
Testo completoAbstract (sommario):
Study Design: Retrospective cohort study. Objective: To examine the effects of concomitant decompression adjacent to the posterior lumbar interbody fusion (PLIF) segment on the clinical and radiological outcomes 5 years after surgery. Methods: Forty-five consecutive patients who had undergone L3/4 decompression with L4/5 PLIF for multilevel stenosis with degenerative spondylolisthesis (DS), and were followed for 5 years, were enrolled (group D). As a control group, 45 age-, sex- and preoperative disc height at L3/4–matched patients who had undergone L4/5 PLIF alone for L4/5DS were randomly selected (group A). Disc height, vertebral slippage, range of motion, posterior opening angle, segmental lordotic angle, presence of the intradiscal vacuum phenomenon (IVP) at the L3/4 level were measured on radiographs. Japanese Orthopaedic Association (JOA) score and the requirement for additional L3/4 surgery were evaluated. Results: In terms of pre-/postoperative radiographic changes between the groups, significant differences were detected regarding disc height narrowing of ≥3 mm (group D 31%, group A 9%) and IVP (group D 33%, group A 11%). There were no significant differences in other radiological parameters. The recovery rate of the JOA score (group D 58%, group A 61%) and reoperation rate (group D 2.2%, group A 6.7%) were not significantly different between the groups. Conclusion: Concomitant decompression adjacent to the PLIF segment accelerated adjacent disc degeneration compared to PLIF alone, but it did not predispose to the development of instability 5 years after surgery. Moreover, the JOA score and reoperation rate were not significantly different between groups D and A.
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Matsukura, Yu, Toshitaka Yoshii, Shingo Morishita, Kenichiro Sakai, Takashi Hirai, Masato Yuasa, Hiroyuki Inose et al. "Comparison of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion as Corrective Surgery for Patients with Adult Spinal Deformity—A Propensity Score Matching Analysis". Journal of Clinical Medicine 10, n. 20 (15 ottobre 2021): 4737. http://dx.doi.org/10.3390/jcm10204737.
Testo completoAbstract (sommario):
Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.
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Fan, Guoxin, Xinbo Wu, Shunzhi Yu, Qi Sun, Xiaofei Guan, Hailong Zhang, Xin Gu e Shisheng He. "Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis". BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/9540298.
Testo completoAbstract (sommario):
The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P>0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P<0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P<0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis.
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MERLO, AVELINO AGUILAR, RICARDO ROJAS BECERRIL, MARIO LORETO LUCAS e SHEILA PATRICIA VÁZQUEZ ARTEAGA. "COMPLICATIONS IN THREE LUMBAR ARTHRODESIS TECHNIQUES: TLIF, MITLIF, PLIF". Coluna/Columna 16, n. 1 (gennaio 2017): 74–77. http://dx.doi.org/10.1590/s1808-185120171601139900.
Testo completoAbstract (sommario):
ABSTRACT Objective: To determine that minimally invasive transforaminal lumbar fusion has fewer complications of chronic lumbar instability compared with traditional open techniques. Methods: Retrospective, observational study of 132 patients with grade I and II lumbar spondylolisthesis with advanced disc degeneration. Forty-five patients operated by minimally invasive transforaminal lumbar interbody fusion (MITLIF), 45 patients operated by posterior lumbar interbody fusion (PLIF) and 42 patients operated by open transforaminal lumbar interbody fusion (TLIF). Results: Four patients had incidental durotomy, two in the TLIF group and two in the PLIF group. There were no cases of incidental durotomy in the minimally invasive transforaminal access group. No patient in the study presented an inadequate screw position, the lowest mean bleeding occurred in the group of minimally invasive instrumentation of one and two levels. There were 6.6% of infections for PLIF group and none in the other two groups. Conclusions: Arthrodesis techniques are not free of complications, however, the frequency is lower with minimally invasive techniques. Nonetheless, it requires training and does not dispense the need for a learning curve for the spine surgeon compared to open lumbar fusion techniques.
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Lee, Ji-Ho, Dong-Oh Lee, Jae Hyup Lee e Hee Jong Shim. "Effects of Lordotic Angle of a Cage on Sagittal Alignment and Clinical Outcome in One Level Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation". BioMed Research International 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/523728.
Testo completoAbstract (sommario):
This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups.
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LI, Chun-de, Hao-lin SUN e Hong-zhang LU. "Comparison of the effect of posterior lumbar interbody fusion with pedicle screw fixation and interspinous fixation on the stiffness of adjacent segments". Chinese Medical Journal 126, n. 9 (5 maggio 2013): 1732–37. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20112393.
Testo completoAbstract (sommario):
Background Adjacent segment degeneration could seriously affect the long-term prognosis of lumbar fusion. Dynamic fixation such as the interspinous fixation, which is characterized by retaining the motion function of the spinal segment, has obtained satisfactory short-term effects in the clinical setting. But there are few reports about the biomechanical experiments on whether dynamic fixation could prevent adjacent segment degeneration. Methods The surgical segments of all 23 patients were L4/5. Thirteen patients with disc herniation of L4/5 underwent Wallis implantation surgery, and 10 patients with spinal stenosis of L4/5 underwent posterior lumbar interbody fusion (PLIF). L3-S1 segmental stiffness and displacement were measured by a spine stiffness gauge (SSG) device during surgery when the vertebral plate was exposed or during spinal decompression or internal fixation. Five fresh, frozen cadavers were used in the self control experiment, which was carried out in four steps: exposure of the vertebral plate, decompression of the spinal canal, implantation of a Wallis fixing device, and PLIF of L4/5 after removing the Wallis fixing device. Then, L3-S1 segment stiffness was measured by an SSG device. Results The experiments showed that the average stiffness of the L4/5 segment was (37.1±8.9) N/mm after exposure of the vertebral plate, while after spinal decompression, the average stiffness fell to (26.2±7.1) N/mm, decreasing by 25.8% (P <0.05). For the adjacent segments L3/4 and L5/S1, their stiffness showed no significant difference between the L4/5 segment decompression and the exposure of the vertebral plate (P >0.05). After Wallis implantation of L4/5, the stiffness of the cephalic adjacent segment L3/4 was (45.8±10.7) N/mm, which was 20.5% more than that after the exposure of the vertebral plate (P <0.05); after L4/5 PLIF surgery, the stiffness of L3/4 was (35.3±10.7) N/mm and was decreased by 12.4% more than that after the exposure of the vertebral plate (P <0.05). The stiffness of the cephalic adjacent segment L3/4 after fixation in the Wallis group was significantly higher than that of the PLIF group (P <0.05). Cadaver experiments showed that the stiffness of the cephalic adjacent segment in the Wallis group was significantly higher than that of the PLIF group after L4/5 segment fixation (P <0.05); the stiffness of the L5/S1 segment showed no significant difference between PLIF surgery and Wallis implantation (P >0.05). Conclusions After interspinous (Wallis) fixation, the stiffness of the cephalic adjacent segment increased. After PLIF with pedicle screw fixation, the stiffness of the cephalic adjacent segment decreased. An interspinous fixation system (Wallis) has a protective effect for cephalic adjacent segments for the immediate post-operative state.
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HAYAKAWA, Shusaku, Masaki HORIGUCHI, Koichi HAYASHI, Satoru OGAWA, Mitsuo GOMI e Kazuo SUZUKI. "110 PLIF Measurements of OH and NO in a Ramjet Combustor". Proceedings of Conference of Tohoku Branch 2000.35 (2000): 22–23. http://dx.doi.org/10.1299/jsmeth.2000.35.22.
Testo completo
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Lee, Chong-Suh, Kyung-Chung Kang, Sung-Soo Chung, Ki-Tack Kim e Seong-Kee Shin. "Incidence of microbiological contamination of local bone autograft used in posterior lumbar interbody fusion and its association with postoperative spinal infection". Journal of Neurosurgery: Spine 24, n. 1 (gennaio 2016): 20–24. http://dx.doi.org/10.3171/2015.3.spine14578.
Testo completoAbstract (sommario):
OBJECT The aim of this study was to examine the results of microbiological cultures from local bone autografts used in posterior lumbar interbody fusion (PLIF) and to identify their association with postoperative spinal infection. METHODS The authors retrospectively evaluated cases involving 328 patients who had no previous spinal surgeries and underwent PLIF for degenerative diseases with a minimum 1-year follow-up. Local bone was obtained during laminectomy, and microbiological culture was performed immediately prior to bone grafting. The associations between culture results from local bone autografts and postoperative spinal infections were evaluated. RESULTS The contamination rate of local bone was 4.3% (14 of 328 cases). Coagulase-negative Staphylococcus (29%) was the most common contaminant isolated, followed by Streptococcus species and methicillin-sensitive Staphylococcus aureus. Of 14 patients with positive culture results, 5 (35.7%) had postoperative spinal infections and were treated with intravenous antibiotics for a minimum of 4 weeks. One of these 5 patients also underwent reoperation for debridement during this 4-week period. Regardless of the microbiological culture results, the infection rate after PLIF with local bone autograft was 2.4% (8 of 328 cases), with 5 (62.5%) of 8 patients showing positive results on autograft culture. CONCLUSIONS The incidence of contamination of local bone autograft during PLIF was considerable, and positive culture results were significantly associated with postoperative spinal infection. Special attention focused on the preparation of local bone for autograft and its microbiological culture will be helpful for the control of postoperative spinal infection.
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Fang, Xinbo, Mingjie Zhang, Lili Wang e Zhengke Hao. "Comparison of PLIF and TLIF in the Treatment of LDH Complicated with Spinal Stenosis". Journal of Healthcare Engineering 2022 (26 marzo 2022): 1–5. http://dx.doi.org/10.1155/2022/9743283.
Testo completoAbstract (sommario):
Objective. The purpose was to compare the clinical effects of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar disc herniation (LDH) complicated with spinal stenosis. Methods. 96 LDH patients complicated with spinal stenosis treated in our hospital (April 2018–April 2020) were chosen as the subjects, and split into the PLIF group and the TLIF group according to different surgical approaches, with 48 cases in each group. The clinical effects of the two groups were compared. Results. There was no significant difference in hospitalization time between the two groups ( P > 0.05 ). Compared with the PLIF group, the TLIF group had obviously shorter operation time and greatly lesser intraoperative blood loss ( P < 0.05 ). The Numerical Rating Scale (NRS) scores of lower limb pain and low back pain in the two groups at 3 months after surgery were significantly lower than those before surgery ( P < 0.001 ). The Japanese Orthopaedic Association (JOA) scores of the two groups at 3 months after surgery were significantly higher than those before surgery ( P < 0.001 ). The Spitzer Quality of Life Index (SQLI) scores of the two groups at 3 months after surgery were significantly higher than those before surgery ( P < 0.001 ). Conclusion. The two surgical approaches have similar efficacy in treating LDH complicated with spinal stenosis. However, PLIF is better than TLIF in terms of operation time and intraoperative blood loss, which should be adopted as the preferred surgical scheme.
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Barnes, Bryan, Mark R. McLaughlin, Barry Birch, Gerald E. Rodts e Regis W. Haid. "Threaded cortical bone dowels for lumbar interbody fusion: technique and short-term results". Neurosurgical Focus 7, n. 6 (dicembre 1999): E8. http://dx.doi.org/10.3171/foc.1999.7.6.9.
Testo completoAbstract (sommario):
The authors retrospectively reviewed a series of cases involving mechanical low-back or disogenic pain; 35 patients underwent lumbar interbody fusion in which threaded cortical bone dowels (TCBDs) were placed to treat degenerative disc disease. The series was composed of 18 females, and 17 males whose mean age was 46 years (range 17-76 years). There were nine smokers in the group. All patients presented with symptoms consistent with mechanical low-back or discogenic pain, and magnetic resonance imaging–documented degenerative changes and disc collapse greater than 50%, as compared with the adjacent normal-appearing level, were confirmed. Twenty-three patients underwent a posterior lumbar interbody fusion (PLIF) procedure for placement of the TCBD, whereas 12 underwent an anterior lumbar interbody fusion (ALIF) procedure for placement of the TCBD. In all patients undergoing PLIF procedures pedicle screw and rod constructs were used without posterolateral fusion except one. In all cases of ALIF except one TCBDs were used as “stand-alone” devices without supplemental fixation. All TCBDs were packed with morselized cancellous autograft prior to implantation. The success of fusion was determined at follow-up intervals and was defined as: the absence of lucency around the TCBD; an increase in subchondral endplate sclerosis; and the presence of bridging bone incorporating the anterior bone graft as demonstrated on static lumbar radiographs and/or computerized tomography scans. Stability was also determined by an absence of movement on dynamic lumbar radiographs. The degree of lumbar lordosis at the diseased level was measured immediately postoperatively and compared with the change in lordosis at follow up. Outcomes were assessed using a modified Prolo outcome scale and rated as excellent, good, fair, or poor. Excellent and good outcomes were considered satisfactory; fair or poor outcomes were considered unsatisfactory. In 27 patients radiographic and clinical follow-up results were considered adequate (nine ALIF and 18 PLIF patients). The mean follow-up duration was 7.9 months. Overall satisfactory outcome was 70%: a 77% satisfactory outcome in PLIF patients and a 55% in ALIF patients. Osseous fusion was present in 94% of the patients in the PLIF group and in 33% of those in the ALIF group. Complications included one L-5 nerve root injury and two postoperative wound infections, all in patients who underwent PLIF; there was also a case of breakout of one implant at 8 months postoperatively. The degree of vertebral body angulation measured at last follow up compared with the measurement obtained immediately postoperative was 3.4° of kyphosis in the ALIF group and 3.1° of kyphosis in the PLIF group, which represented an 11% and 9% loss of lordosis, respectively. Preliminary results indicate that there is a dramatically higher fusion rate in PLIF compared with ALIF procedures in which TCBDs are used. There is a corresponding trend seen in patient outcomes, but no distinct difference seems apparent in terms of restoration of lordosis when performing either procedure. The results suggest that TCBDs may best be used in PLIF procedures in conjunction with pedicle screws and rod constructs. Moreover, in patients in whom TCBDs and supplemental tension band constructs are used fusion rates appear to be comparable with those reported in other series but at a faster rate (94% at 7.9 months mean follow up). Longer follow-up periods and a larger series of patients are needed to confirm these preliminary observations.
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Kushioka, Junichi, Tomoya Yamashita, Shinya Okuda, Takafumi Maeno, Tomiya Matsumoto, Ryoji Yamasaki e Motoki Iwasaki. "High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion". Journal of Neurosurgery: Spine 26, n. 3 (marzo 2017): 363–67. http://dx.doi.org/10.3171/2016.8.spine16528.
Testo completoAbstract (sommario):
OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF. METHODS The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups. RESULTS There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p < 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p < 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p < 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events. CONCLUSIONS High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.
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Wrangel, Christof, Ali Karakoyun, Kaye-Marie Buchholz, Olaf Süss, Theodoros Kombos, Johannes Woitzik, Peter Vajkoczy e Marcus Czabanka. "Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability". Journal of Neurological Surgery Part A: Central European Neurosurgery 78, n. 06 (11 agosto 2017): 556–60. http://dx.doi.org/10.1055/s-0037-1604284.
Testo completoAbstract (sommario):
Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning. Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease. Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively. Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.
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Nakashima, Hiroaki, Tokumi Kanemura, Kotaro Satake, Kenyu Ito, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi e Shiro Imagama. "Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery". Asian Spine Journal 14, n. 3 (30 giugno 2020): 305–11. http://dx.doi.org/10.31616/asj.2019.0194.
Testo completoAbstract (sommario):
Study Design: Retrospective comparative study.Purpose: We compared clinical and radiographical outcomes after lumbar decompression revision surgery for restenosis by lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF).Overview of Literature: Indirect lumbar decompression with LLIF was used to treat degenerative lumbar diseases requiring neural decompression. However, only a few studies have focused on the effectiveness of this technique for restenosis after lumbar decompression.Methods: We retrospectively investigated 52 cases involving lumbar interbody fusions for restenosis with spondylolisthesis after lumbar decompressions; these cases consisted of 15 patients who underwent indirect decompression with LLIF and posterior fixation and 37 patients who underwent the same procedure with PLIF. We compared Japanese Orthopaedic Association (JOA) scores and perioperative complications between groups. The cross-sectional areas of the thecal sac on magnetic resonance imaging were measured before, immediately after, and 2 years after surgery. We conducted statistical analyses using unpaired t -test and Fisher’s exact tests, and a <i>p</i> -value <0.05 was considered statistically significant.Results: The operative time was significantly shorter in the LLIF group than in the PLIF group (115.3±33.6 min vs. 186.2±34.2 min, respectively; <i>p</i> <0.001). In addition, the intraoperative blood loss was significantly lower in the LLIF group than in the PLIF group (58.2±32.7 mL vs. 303.2±140.1 mL, respectively; <i>p</i> <0.001). We found two cases of transient lateral thigh weakness (13.3%) in the LLIF group and five cases of incidental durotomy, one case of deep infection, and one case of neurological deterioration in the PLIF group—resulting in a higher complication incidence (18.9%), although it did not reach (<i>p</i> =0.63). The JOA scores improved significantly in both groups.Conclusions: Indirect decompression using LLIF provided acceptable clinical and radiographical outcomes in patients with restenosis with spondylolisthesis after lumbar decompression; no revision-surgery-specific complications were found. Our results suggest that LLIF is a safe and minimally invasive procedure for revision surgery.
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Chen, Ming-Hong, e Jen-Yuh Chen. "A Novel Nonpedicular Screw-Based Fixation in Lumbar Spondylolisthesis". BioMed Research International 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/5619350.
Testo completoAbstract (sommario):
Objective. The authors present the clinical results obtained in patients who underwent interspinous fusion device (IFD) implantation following posterior lumbar interbody fusion (PLIF). The purpose of this study is investigating the feasibility of IFD with PLIF in the treatment of lumbar spondylolisthesis. Methods. Between September 2013 and November 2014, 39 patients underwent PLIF and subsequent IFD (Romeo®2 PAD, Spineart, Geneva, Switzerland) implantation. Medical records of these patients were retrospectively reviewed to collect relevant data such as blood loss, operative time, and length of hospital stay. Radiographs and clinical outcome were evaluated 6 weeks and 12 months after surgery. Results. All 39 patients were followed up for more than one year. There were no major complications such as dura tear, nerve injuries, cerebrospinal fluid leakage, or deep infection. Both interbody and interspinous fusion could be observed on radiographs one year after surgery. However, there were 5 patients having early retropulsion of interbody fusion devices. Conclusion. The interspinous fusion device appears to achieve posterior fixation and facilitate lumbar fusion in selected patients. However, further study is mandatory for proposing a novel anatomic and radiological scoring system to identify patients suitable for this treatment modality and prevent postoperative complications.
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Suess, Olaf, Theodoros Kombos e Frank Bode. "The Negligible Influence of Chronic Obesity on Hospitalization, Clinical Status, and Complications in Elective Posterior Lumbar Interbody Fusion". International Journal of Chronic Diseases 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/2964625.
Testo completoAbstract (sommario):
Background. Posterior lumbar interbody fusion (PLIF) is a common surgical treatment for degenerative spinal instability, but many surgeons consider obesity a contraindication for elective spinal fusion. The aim of this study was to analyze whether obesity has any influence on hospitalization parameters, change in clinical status, or complications.Methods. In this prospective study, regression analysis was used to analyze the influence of the body mass index (BMI) on operating time, postoperative care, hospitalization time, type of postdischarge care, change in paresis or sensory deficits, pain level, wound complications, cerebrospinal fluid leakage, and implant complications.Results. Operating time increased only 2.5 minutes for each increase of BMI by 1. The probability of having a wound complication increased statistically with rising BMI. Nonetheless, BMI accounted for very little of the variation in the data, meaning that other factors or random chances play a much larger role.Conclusions. Obesity has to be considered a risk factor for wound complications in patients undergoing elective PLIF for degenerative instability. However, BMI showed no significant influence on other kinds of peri- or postoperative complications, nor clinical outcomes. So obesity cannot be considered a contraindication for elective PLIF.
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Goldstein, Christina L., Kevin Macwan, Kala Sundararajan e Y. Raja Rampersaud. "Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review". Journal of Neurosurgery: Spine 24, n. 3 (marzo 2016): 416–27. http://dx.doi.org/10.3171/2015.2.spine14973.
Testo completoAbstract (sommario):
OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23–0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry Disability Index scores were slightly better in the patients undergoing MIS (n = 346) versus open TLIF/PLIF (n = 346) at a median follow-up time of 24 months (mean difference [MIS – open] = 3.32, p = 0.001). CONCLUSIONS The result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias.
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Barnes, Bryan, Gerald E. Rodts, Regis W. Haid, Brian R. Subach e Mark R. McLaughlin. "Allograft Implants for Posterior Lumbar Interbody Fusion: Results Comparing Cylindrical Dowels and Impacted Wedges". Neurosurgery 51, n. 5 (1 novembre 2002): 1191–98. http://dx.doi.org/10.1097/00006123-200211000-00014.
Testo completoAbstract (sommario):
Abstract OBJECTIVE With the proliferation of implant types available for use in posterior lumbar interbody fusion (PLIF) procedures, the choices for surgeons have become increasingly complex. The goal of this study was to retrospectively review a series of 49 patients who underwent PLIF with the use of allograft cylindrical threaded cortical bone dowels (TCBDs) and allograft impacted wedges. Nerve root injury rates, fusion rates, and clinical outcomes of the allograft impacted wedge group are compared with those in the allograft cylindrical TCBD group. METHODS We performed a retrospective chart and radiographic review of 49 patients. Twenty-seven patients underwent PLIF with impacted allograft wedges, and 22 patients underwent PLIF with allograft cylindrical TCBD. Permanent nerve root injury rates, fusion rates, and clinical outcomes were assessed on the basis of a minimum of 1 year of follow-up data in this nonconsecutive series. RESULTS Permanent nerve root injuries in the impacted wedge and TCBD groups were documented with physical examinations conducted pre- and postoperatively. The cylindrical TCBD group showed a 13.6% rate of permanent nerve root injury, and the impacted wedge group demonstrated a 0% rate, and these rates were statistically significant (analysis of variance, P = 0.049). The fusion rate at a mean of 13.9 months of follow-up was 95.4% in patients in whom the cylindrical TCBD was implanted and 88.9% after a mean of 17.4 months of follow-up in patients in whom impacted wedges were used. The fusion rate difference between the TCBD and impacted wedge groups was not significant. The satisfactory outcome rate was 72.7% for the TCBD group and 85.1% for the impacted wedge group, and the impacted wedge group was found to have a significantly higher rate of satisfactory outcomes (P = 0.016, analysis of variance). Analysis of the patient outcomes in the TCBD and impacted wedge groups according to sex, mean length of follow-up, workman's compensation claim rate, and smoking habit yielded no significant difference. CONCLUSION With a minimum of 1 year of follow-up in this nonconsecutive series of 49 patients, a comparison of the use of allograft TCBD versus allograft impacted wedges in PLIF procedures reveals a statistically significant increase in permanent nerve root injury rates with the use of cylindrical TCBD implants as compared with impacted allograft wedges. There is no difference between the two groups in terms of fusion rates, and clinical outcomes with the use of impacted wedges were significantly better.
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Shen, Xu, Xiang Gao, Zhongshan Li, Bo Li, Chenghang Zheng, Zhiwei Sun, Mingjiang Ni, Kefa Cen e Marcus Aldén. "PLIF diagnostics of NO oxidization and OH consumption in pulsed corona discharge". Fuel 102 (dicembre 2012): 729–36. http://dx.doi.org/10.1016/j.fuel.2012.07.011.
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Ji, Xianqun, Xiaochen Wang, Liang Shi e Fangtao Tian. "Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study". Medicine 102, n. 46 (17 novembre 2023): e35911. http://dx.doi.org/10.1097/md.0000000000035911.
Testo completoAbstract (sommario):
The use of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) surgery is believed to be beneficial for reducing intraoperative blood loss, postoperative drainage volume (PDV), and length of hospital stay (LOS). However, whether continued administration of intravenous TXA within 24 hours after surgery is more beneficial to patients has not yet been studied. This study prospectively analyzed the perioperative outcomes of patients who received and did not receive intravenous TXA within 24 hours after PLIF (≥2 segments) surgery from January 2018 to December 2021. A total of 78 and 69 patients were included in the TXA (receive intravenous TXA intraoperatively and within 24 hours postoperatively) and non-TXA (only receive intravenous TXA intraoperatively) groups, respectively. No significant differences were observed in the intraoperative blood loss and operative time between the 2 groups. The postoperative drainage volume, postoperative drainage time, and length of hospital stay in the TXA group were significantly lower than those in the non-TXA group. The rates and volumes of postoperative blood and albumin transfusions were significantly lower in the TXA group than those in the non-TXA group. No significant differences were observed in the perioperative complication rates between the 2 groups. No increase in thrombosis-related complications was observed with postoperative TXA administration. Short-term TXA use after PLIF (≥2 segments) surgery is safe. In addition to intraoperative use of TXA, additionally administration of intravenous TXA within 24 hours postoperatively can improve the perioperative clinical outcomes of patients without increasing the risk of thrombotic events.
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Eryılmaz, Fahri. "Contrasted the clinical and radiological results of patients receiving cage-based bone grafting with PLIF surgical treatment that included bone grafting". Journal of Comprehensive Surgery 2, n. 3 (27 agosto 2024): 49–55. http://dx.doi.org/10.51271/jocs-0035.
Testo completoAbstract (sommario):
Aims: Posterior lumbar interbody fusion (PLIF) is frequently used to treat spinal instabilities that can cause neurological symptoms, leg pain and low back pain including lumbar stenosis, degenerative disc disease and spondylolisthesis in which one vertebra slips over another. This study aimed to compare the clinical and radiographic outcomes of PLIF for degenerative L4 unstable grade III spondylolisthesis using bone grafts and cage bone grafts. Methods: Between from September 2021 to August 2023, 30 patients with degenerative lumbar spine disorders were selected based on the inclusion and exclusion criteria for PLIF. Results: We enrolled 30 patients and divided them into 15 groups (bone graft group I and Cage bone graft group II). The follow-up period was 2 years. Low back pain and leg function of the Japanese Orthopaedic Association (JOA) score showed significant improvement (p <0.005) at 3 months and at the final postoperative (62.1±5.5, 602±5.1) in both groups. The fusion rate was 93% in group I and 83% in group II. Radiological evaluation showed significant changes in slip angle, disc height, lumbar lordosis and translational motion from preoperative to final follow-up in both groups. A computer tomography (CT) revealed bilateral spondylolysis, disc collapse and anterolisthesis of the fifth lumbar vertebra. These results were verified by magnetic resonance imaging (MRI). There was no spinal canal stenosis. Conclusion: This finding suggests that successful clinical and radiological results can be obtained with PLIF surgery using either a cage with bone or a bone graft alone. The surgeon's inclination, the particular state of the patient and the resources at hand may influence which of the two approaches is used. The results showed no statistically significant difference between the two groups in terms of clinical and radiological outcomes (bone graft and cage with bone graft). This indicates that neither strategy showed a clear edge over the others in the criteria under study and both were equally successful in yielding favorable outcomes.
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Yoshimoto, Hisashi, Shigenobu Sato, Izumi Nakagawa, Takahiko Hyakumachi, Yasushi Yanagibashi, Fumihito Nitta e Takeshi Masuda. "Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion". Journal of Neurosurgery: Spine 6, n. 1 (gennaio 2007): 47–51. http://dx.doi.org/10.3171/spi.2007.6.1.47.
Testo completoAbstract (sommario):
✓The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5–S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient’s leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.
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Zuo, Xiao-Lin, e Yan Wen. "Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion". Frontiers of Nursing 10, n. 2 (1 giugno 2023): 203–11. http://dx.doi.org/10.2478/fon-2023-0021.
Testo completoAbstract (sommario):
Abstract Objectives To explore the risk factors and nursing measures of early surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). Methods A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study. According to the occurrence of early SSI, the patients were divided into two groups, and the general data were analyzed by univariate analysis. Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures. Results Among 468 patients with PLIF, 18 patients developed early SSI (3.85%). The proportion of female, age, diabetes mellitus and urinary tract infection (UTI), operation segment, operation time, post-operative drainage volume, and drainage time were significantly higher than those in the uninfected group, with statistical significance (P < 0.05), whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group, with statistical significance (P < 0.05). There was no significant difference between the two groups in the American Society of Anesthesiologists (ASA) grading, body mass index (BMI), complications including cardiovascular and cerebrovascular diseases or hypertension (P > 0.05). Logistic regression analysis showed that preoperative diabetes mellitus (OR = 2.109, P = 0.012)/UTI (OR = 1.526, P = 0.035), prolonged drainage time (OR = 1.639, P = 0.029) were risk factors for early SSI. Men (OR = 0.736, P = 0.027) and albumin level (OR = 0.526, P = 0.004) were protective factors in reducing early SSI. Conclusions Women, preoperative diabetes/UTI, hypoproteinemia, and prolonged drainage time are risk factors for early SSI after PLIF. Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.