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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

By angulating the tubular retractor so that its distal end is facing more towards the opposite side of the surgeon, visualization and access to the contralateral side are improved. Tilting the table towards the opposite side, as seen in the figure, can help the surgeon maintain a more natural posture, as the retractor would be more perpendicular to the floor.
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fig4: By angulating the tubular retractor so that its distal end is facing more towards the opposite side of the surgeon, visualization and access to the contralateral side are improved. Tilting the table towards the opposite side, as seen in the figure, can help the surgeon maintain a more natural posture, as the retractor would be more perpendicular to the floor.

Mentions: All operations were performed by one senior author (JS Kim). All MIS-TLIF procedures were done via unilateral approach. Under fluoroscopic guidance, a 2~3 cm paraspinal skin incision is made between the L5 and S1 pedicles on anteroposterior image. After an incision is made on the lumbodorsal fascia between the multifidus and longissimus muscles, sequential widening of the incision is made using tubular dilators (Insight Access Retractor System, DePuy-Synthes Spine, Massachusetts, USA), and a 24 mm working channel is docked. Under microscope visualization, total facetectomy and partial laminectomy are performed using a combination of osteotome and high-speed burr and Kerrison rongeurs. The ligamentum flavum is resected and nerve root is retracted medially. Complete discectomy is performed, and meticulous preparation of the central and contralateral endplates is performed with angled ring curettes. Patients with bilateral foraminal stenosis on MRI or CT with corresponding symptoms underwent bilateral decompression through the unilateral laminofacetectomy site. This is done by resecting portions of the contralateral inferior articular process, lamina, and ligamentum flavum through the corridor created by ipsilateral laminofacetectomy. In order to facilitate better visualization of the contralateral side, the tubular retractor needs to be angled so that the distal end of the retractor is facing the base of the spinous process, away from the surgeon. Tilting the table away from the surgeon after repositioning the retractor can help the surgeon maintain a more natural and comfortable posture during the operation (Figure 4).


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)

By angulating the tubular retractor so that its distal end is facing more towards the opposite side of the surgeon, visualization and access to the contralateral side are improved. Tilting the table towards the opposite side, as seen in the figure, can help the surgeon maintain a more natural posture, as the retractor would be more perpendicular to the floor.
© Copyright Policy
Related In: Results  -  Collection

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

fig4: By angulating the tubular retractor so that its distal end is facing more towards the opposite side of the surgeon, visualization and access to the contralateral side are improved. Tilting the table towards the opposite side, as seen in the figure, can help the surgeon maintain a more natural posture, as the retractor would be more perpendicular to the floor.
Mentions: All operations were performed by one senior author (JS Kim). All MIS-TLIF procedures were done via unilateral approach. Under fluoroscopic guidance, a 2~3 cm paraspinal skin incision is made between the L5 and S1 pedicles on anteroposterior image. After an incision is made on the lumbodorsal fascia between the multifidus and longissimus muscles, sequential widening of the incision is made using tubular dilators (Insight Access Retractor System, DePuy-Synthes Spine, Massachusetts, USA), and a 24 mm working channel is docked. Under microscope visualization, total facetectomy and partial laminectomy are performed using a combination of osteotome and high-speed burr and Kerrison rongeurs. The ligamentum flavum is resected and nerve root is retracted medially. Complete discectomy is performed, and meticulous preparation of the central and contralateral endplates is performed with angled ring curettes. Patients with bilateral foraminal stenosis on MRI or CT with corresponding symptoms underwent bilateral decompression through the unilateral laminofacetectomy site. This is done by resecting portions of the contralateral inferior articular process, lamina, and ligamentum flavum through the corridor created by ipsilateral laminofacetectomy. In order to facilitate better visualization of the contralateral side, the tubular retractor needs to be angled so that the distal end of the retractor is facing the base of the spinous process, away from the surgeon. Tilting the table away from the surgeon after repositioning the retractor can help the surgeon maintain a more natural and comfortable posture during the operation (Figure 4).

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