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Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes.

Choi WS, Kim JS, Ryu KS, Hur JW, Seong JH - Biomed Res Int (2016)

Bottom Line: The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up.PSR was 88%.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University, Seoul 06591, Republic of Korea.

ABSTRACT
Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF) at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH), disc angle (DA), disc slope angle, segmental lordotic angle (SLA), lumbar lordotic angle (LLA), and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS), Oswestry disability index (ODI), and patient satisfaction rate (PSR) were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21) at 12 months' follow-up. The most common cage position was anteromedial (15/21). The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21). Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable.

No MeSH data available.


Related in: MedlinePlus

A: anterior, M: medial, L: lateral, and P: posterior.
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fig3: A: anterior, M: medial, L: lateral, and P: posterior.

Mentions: Modified Bridwell fusion criteria [20, 21] (Table 1) for the lumbar spine were used to assess fusion on CT scan of the lumbar spine at 6 and 12 months after operation, and additional annual follow-up CT scans were also analyzed when available. Only grades I and II were considered satisfactory fusion. Position of the cage on the axial CT scan image was analyzed using a 3 × 3 grid system. The axial image of the vertebral body was divided into 9 segments by overlapping a 3 × 3 grid onto the image, and the area of the grid occupied by the interbody cage was assessed (Figure 3). Any cage subsidence or endplate violation, defined as 2 mm or more migration of the interbody cage into the adjacent vertebral bodies on coronal and sagittal CT reconstruction images, was also noted when identified during postoperative follow-up examinations.


Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes.

Choi WS, Kim JS, Ryu KS, Hur JW, Seong JH - Biomed Res Int (2016)

A: anterior, M: medial, L: lateral, and P: posterior.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940521&req=5

fig3: A: anterior, M: medial, L: lateral, and P: posterior.
Mentions: Modified Bridwell fusion criteria [20, 21] (Table 1) for the lumbar spine were used to assess fusion on CT scan of the lumbar spine at 6 and 12 months after operation, and additional annual follow-up CT scans were also analyzed when available. Only grades I and II were considered satisfactory fusion. Position of the cage on the axial CT scan image was analyzed using a 3 × 3 grid system. The axial image of the vertebral body was divided into 9 segments by overlapping a 3 × 3 grid onto the image, and the area of the grid occupied by the interbody cage was assessed (Figure 3). Any cage subsidence or endplate violation, defined as 2 mm or more migration of the interbody cage into the adjacent vertebral bodies on coronal and sagittal CT reconstruction images, was also noted when identified during postoperative follow-up examinations.

Bottom Line: The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up.PSR was 88%.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University, Seoul 06591, Republic of Korea.

ABSTRACT
Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF) at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH), disc angle (DA), disc slope angle, segmental lordotic angle (SLA), lumbar lordotic angle (LLA), and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS), Oswestry disability index (ODI), and patient satisfaction rate (PSR) were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21) at 12 months' follow-up. The most common cage position was anteromedial (15/21). The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21). Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable.

No MeSH data available.


Related in: MedlinePlus