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Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain.

Deukmedjian AJ, Cianciabella AJ, Cutright J, Deukmedjian A - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: Average blood loss was 108 ml perfused level.Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4).Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.

View Article: PubMed Central - PubMed

Affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.

ABSTRACT

Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD.

Materials and methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS).

Results: The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.

Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

No MeSH data available.


Related in: MedlinePlus

Lateral postoperative X-ray demonstrates typical surgical construct and alignment
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Figure 1: Lateral postoperative X-ray demonstrates typical surgical construct and alignment

Mentions: All patients underwent surgery with general anesthesia and complete neuromuscular blockade. Patients were positioned prone on a “Jackson” spinal table to optimize lumbar lordosis and minimize venous bleeding from increased abdominal pressure. The entire procedure was performed through a single posterior midline incision with subperiosteal muscle dissection using a Bovie monopolar and a wide exposure to the lateral aspect of the facet joints. Laminectomy with bilateral pars osteotomy for removal of abnormal facet joints was performed at each fused level. Through a unilateral transforaminal approach the degenerated disc was removed, the vertebral body end plates decorticated with a rasp, the disc space was partially filled with local autograft and synthetic allograft and finally a tall PEEK cage was implanted into the interbody space. Segmental, bilateral polyaxial pedicle screw rod fixation with crosslinks was placed at all levels treated using lateral fluoroscopic guidance [Figure 1]. Finally, posterolateral intertransverse fusion with local autograft and allograft was performed.


Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain.

Deukmedjian AJ, Cianciabella AJ, Cutright J, Deukmedjian A - J Craniovertebr Junction Spine (2015 Oct-Dec)

Lateral postoperative X-ray demonstrates typical surgical construct and alignment
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660495&req=5

Figure 1: Lateral postoperative X-ray demonstrates typical surgical construct and alignment
Mentions: All patients underwent surgery with general anesthesia and complete neuromuscular blockade. Patients were positioned prone on a “Jackson” spinal table to optimize lumbar lordosis and minimize venous bleeding from increased abdominal pressure. The entire procedure was performed through a single posterior midline incision with subperiosteal muscle dissection using a Bovie monopolar and a wide exposure to the lateral aspect of the facet joints. Laminectomy with bilateral pars osteotomy for removal of abnormal facet joints was performed at each fused level. Through a unilateral transforaminal approach the degenerated disc was removed, the vertebral body end plates decorticated with a rasp, the disc space was partially filled with local autograft and synthetic allograft and finally a tall PEEK cage was implanted into the interbody space. Segmental, bilateral polyaxial pedicle screw rod fixation with crosslinks was placed at all levels treated using lateral fluoroscopic guidance [Figure 1]. Finally, posterolateral intertransverse fusion with local autograft and allograft was performed.

Bottom Line: Average blood loss was 108 ml perfused level.Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4).Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.

View Article: PubMed Central - PubMed

Affiliation: Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia.

ABSTRACT

Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD.

Materials and methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS).

Results: The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.

Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

No MeSH data available.


Related in: MedlinePlus