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Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion:A meta-analysis with evidence grading

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World Journal of Clinical Cases 2022年第36期10卷 13337-13348页

作者： Lei Sun Ai-Xian Tian Jian-Xiong Ma Xin-Long Ma Orthopedic Research Institute Tianjin HospitalTianjin UniversityTianjin 300050China

BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially *** To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative *** We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 *** intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion ***,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of *** were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of *** Fifteen previous cases of study including 992 participants have been involved in our *** had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody ***,JOA,operation time,total blood loss,as well as length of stay were improve

关键词： Unilateral pedicle screw fixation Bilateral pedicle screw fixation Meta-analysis Spinal fusion surgery Discectomy lumbar interbody fusion

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Treatment of Single Level lumbar Spondylolisthesis with lumbar interbody fusion via Oblique Lateral Approach (OLIF)

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Surgical Science 2023年第1期14卷 46-54页

作者： Jinpeng Zheng Dun Liu Jing Shi Han Wu Ping Cao Bing Hu Department of Orthopedics Tianyou Hospital Affiliated to Wuhan University of Science & Technology Wuhan China

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females;the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded;2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up;by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P < 0.05);the ODI at the last follow-up was lower than that before operation, and the difference was statistically significant (P < 0.05). At the last follow-up, the height of intervertebral space, the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P < 0.05);the spondylolisthesis rate at the last follow-up was lower than that before operation, with a statistically significant difference (P < 0.05). Left thigh surface numbness occurred in 2 cases (6.3%) and dis

关键词： Oblique Lateral Approach lumbar interbody fusion Single Segment lumbar Spondylolisthesis

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Biomechanical evaluation of two fusion techniques based on finite element analysis:Percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion

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Medicine in Novel Technology and Devices 2022年第4期16卷 17-25页

作者： Yang Yan Jiarui Li Jianhao Yu Yan Wang Hao Dong Yuqin Sun Xiaogang Wu Liming He Weiyi Chen Haoyu Feng College of Biomedical Engineering Taiyuan University of TechnologyTaiyuan030024China Shanxi Bethune Hospital Shanxi Academy of Medical SciencesTongji Shanxi HospitalThird Hospital of Shanxi Medical UniversityTaiyuan030032China

As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative *** purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)*** intact FE models of L4-L5 were established and validated based on the CT *** this basis,the FE models of MIS-TLIF and PETLIF were established and *** is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar *** addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.

关键词： Percutaneous endoscopic transforaminal lumbar interbody fusion Minimally invasive surgery Degenerative lumbar diseases Finite element analysis Biomechanics

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Standardizing MI-TLIF, a Proposal for a Reproducible Technique

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Open Journal of Modern Neurosurgery 2024年第2期14卷 91-103页

作者： Iván Ulises Sámano López Jesús Alberto Pérez Contreras Emmanuel Cantú Chávez Diana Chávez Lizárraga Ana Sofía Peña Blesa Thania Karina Gutiérrez Anchondo Á ngeles Pedregal Ciudad de México México

Background: Minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is a widely known and performed technique, however its versatility among different physicians continues to hinder its replication and results. Therefore, this study aimed to provide a step-by-step surgical guide to perform a safe MI-TLIF, based on the results obtained in patients operated on by a single surgeon over a period of 12 years. Patients and methods: A retrospective, single center, longitudinal, and observational cohort study was conducted with 931 patients who underwent MI TLIF by a single surgeon between 2010 and 2022 using the technique described on this paper, each with a minimum follow-up of 12 months. Criteria included Schizas classification, listhesis according to Meyerding classification, number of levels treated, cage size, and complications (screw repositioning or cerebrospinal fluid leak). Patient clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pre- and postoperative radicular pain. Thin slice CT scans were used to assess the progression of the fusion using the Bridwell classification. In the statistical analysis, percentages, median, and interquartile range (IQR) were calculated. Results: Nine hundred and thirty one patients underwent MI TLIF using the technique described, eight hundred and eighty (94.5%) had a single level treated and fifty one (5.5%) had a 2 level procedure (982 levels), an 8mm cage was placed on five hundred and seventeenlevels (52.7%), six hundred and sixty three levels(67.6%) achieved grade I fusion, two hundred and sixty six levels (27.1%) achieved grade II fusion, 52 levels (5.3) achieved grade III fusion and one level (0.1) achieved a grade IV fusion or non-union. Revision surgery was performed on 3 patients (0.3%) for screw repositioning, cerebrospinal fluid leak was present on 2 patients during surgery and treated before closure. VAS scores and ODI were improved at 12 months postop (V

关键词： MITLIF lumbar interbody fusion Technique Pain Relief and Disability

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Application of the cortical bone trajectory technique in posterior lumbar fixation

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World Journal of Clinical Cases 2023年第2期11卷 255-267页

作者： Shi-Bo Peng Xi-Chuan Yuan Wei-Zhong Lu Ke-Xiao Yu Department of Orthopedics Chongqing Nanchuan Hospital of Traditional Chinese MedicineChongqing 408400China Department of Orthopedics Chongqing Hospital of Traditional Chinese MedicineChongqing 400021China

The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and *** unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive *** combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases,including spondylolisthesis or stenosis,and can also be used as a remedy for revision surgery when the pedicle screw *** has obvious advantages in terms of surgical trauma,postoperative recovery,prevention and treatment of adjacent vertebral disease,and the surgical treatment of obese and osteoporosis ***,the concept of CBT internal fixation technology appeared relatively recently;consequently,there are few relevant clinical studies,and the long-term clinical efficacy and related complications have not been ***,large sample and prospective studies are needed to further reveal the long-term complications and fusion *** a supplement to the traditional pedicle trajectory fixation technique,the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

关键词： Cortical bone trajectory Management of midle line fusion lumbar interbody fusion lumbar surgery Review

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