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Mini-open anterior spine surgery for anterior lumbar diseases.

Lin RM, Huang KY, Lai KA - Eur Spine J (2008)

Bottom Line: Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%).There were no major complications.Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70428, Taiwan. linrm@mail.ncku.edu.tw

ABSTRACT
Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified "mini-open anterior spine surgery" (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24-52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12-L1, 18 at L1-L2, 18 at L2-L3, 22 at L3-L4 and 11 at L4-L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62-124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4-26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

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A 57 year-old female who suffered from motion pain and left L5 sciatica for years. Dynamic X-ray showed L4–5 degenerative spondylolisthesis with spinal instability. The MOASS technique was performed and the lower screw was inserted obliquely to avoid ligating the segmental vessels (arrow). She had an excellent clinical outcome; 3.5 years later, we noted solid interbody fusion at L4–5
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Fig2: A 57 year-old female who suffered from motion pain and left L5 sciatica for years. Dynamic X-ray showed L4–5 degenerative spondylolisthesis with spinal instability. The MOASS technique was performed and the lower screw was inserted obliquely to avoid ligating the segmental vessels (arrow). She had an excellent clinical outcome; 3.5 years later, we noted solid interbody fusion at L4–5

Mentions: Tricortical iliac autografts, allografts, rib grafts, chip bone mesh, or hybrids of the same were the fusion materials used. After decompression and grafting, polyaxial MOSS-Miami screws were generally used because of their versatility and low profile. During tightening, the rod would not give way, which would have jeopardized vertebral anchoring, especially for osteoporotic bones. The screws were usually inserted upward and downward so that segmental vessels would be spared (Fig. 2). In osteoporotic bone, PMMA cement hybridized with interpore or cement grafts were used for augmentation of fixation; however, no additional posterior surgery was needed.Fig. 2


Mini-open anterior spine surgery for anterior lumbar diseases.

Lin RM, Huang KY, Lai KA - Eur Spine J (2008)

A 57 year-old female who suffered from motion pain and left L5 sciatica for years. Dynamic X-ray showed L4–5 degenerative spondylolisthesis with spinal instability. The MOASS technique was performed and the lower screw was inserted obliquely to avoid ligating the segmental vessels (arrow). She had an excellent clinical outcome; 3.5 years later, we noted solid interbody fusion at L4–5
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2367411&req=5

Fig2: A 57 year-old female who suffered from motion pain and left L5 sciatica for years. Dynamic X-ray showed L4–5 degenerative spondylolisthesis with spinal instability. The MOASS technique was performed and the lower screw was inserted obliquely to avoid ligating the segmental vessels (arrow). She had an excellent clinical outcome; 3.5 years later, we noted solid interbody fusion at L4–5
Mentions: Tricortical iliac autografts, allografts, rib grafts, chip bone mesh, or hybrids of the same were the fusion materials used. After decompression and grafting, polyaxial MOSS-Miami screws were generally used because of their versatility and low profile. During tightening, the rod would not give way, which would have jeopardized vertebral anchoring, especially for osteoporotic bones. The screws were usually inserted upward and downward so that segmental vessels would be spared (Fig. 2). In osteoporotic bone, PMMA cement hybridized with interpore or cement grafts were used for augmentation of fixation; however, no additional posterior surgery was needed.Fig. 2

Bottom Line: Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%).There were no major complications.Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70428, Taiwan. linrm@mail.ncku.edu.tw

ABSTRACT
Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified "mini-open anterior spine surgery" (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24-52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12-L1, 18 at L1-L2, 18 at L2-L3, 22 at L3-L4 and 11 at L4-L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62-124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4-26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

Show MeSH
Related in: MedlinePlus