Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Brief review

전방경유 요추 유합술과 추간공경유 요추 유합술을 비교하여 술 후의 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목을 측정하여 연구한 논문 입니다.

전방경유 요추 유합술이 추간공경유 요추 유합술에 비해 위에서 언급한 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목에서 우수한 결과를 보였습니다.

이 논문은 방사선학적 측정값이 주를 이루므로 설명보다는 표로 보는게 쉬워서 아래와 같이 첨부했습니다.

*Title: Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

*Authors: PATRICK C. HSIEH, TYLER R. KOSKI, BRIAN A. O’SHAUGHNESSY, PATRICK SUGRUE, SEAN SALEHI, STEPHEN ONDRA, JOHN C. LIU

*Bibliography: J Neurosurg Spine. 2007 Oct;7(4):379-86.

Backgroud of data

-A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance.

-There has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters.

OBJECT

The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.

METHODS

▶Study design : retrospective study(medical records and radiographs review)

▶Subjects: 32 patients (ALIF)+ 25 patients (TLIF) (2000~2004)

▶Data measurement

-Clinical data: VAS score (pre&post:6,12,24mon)

-radiographic data: foraminal height, local disc angle, and lumbar lordosis (pre&post)

▶Statistical analyses: included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.

RESULTS

-ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

▶increasing rate or degree in radiographic data

-foraminal height: 18.5%(ALIF) vs 0.4%(TLIF)

-local disc angle: 8.3 degrees(ALIF) vs 0.1 degree(TLIF)

-lumbar lordosis: 6.2 degrees(ALIF)  vs 2.1 degrees(TLIF)

CONCLUSIONS
-The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

-The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.

Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Brief review

이 논문은 전-후방 경유  유합술 대 추간공경유 요추유합술의 임상적, 방사선학적 결과를 비교한 논문으로, 두 수술을 받은 총 133명의 환자에 대해 차트리뷰와 설문등을 통해 수술 후 환자의 상태를 평가했습니다. 

만족도, 삶의 질 평가점수, 일상생활가능정도는 두 그룹이 비슷하고 수술시간, 재원일수, 출혈량, 수술 중 합병증 률은 전-후방경유 유합술을 받은 환자들이 더 높은 결과를 보여줬습니다. 

 결론부분에서 특이한 점은 없었고 위의 수술 후 결과를 요약한 내용과, 요추 유합술 후의 결과에 영향을 미칠 수 있는 요소들이 매우 많다는 일반적인 사실만 나와있습니다.

*Title: Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients.

전-후방 경유  유합술 대 추간공경유 요추유합술의 임상적, 방사선학적 결과: 133명 환자의 후향적 비교연구.

*Author: Antonio A. Faundez, James D. Schwender, Yair Safriel, Thomas J. Gilbert, Amir A. Mehbod, Francis Denis, Ensor E. Transfeldt, Jill M. Wroblewskia

*Bibliography: Eur Spine J (2009) 18:203–211

Background

There are many data compare anterior/posterior spine fusion (APF) and transforaminal lumbar interbody fusion (TLIF).

*Problem: Only few studies from one institution compares the two techniques.

Method

▶Subject number: 133 patients (68 APF + 65 TLIF)

▶Inclusion criteria:

-Had symptomatic disc degeneration of the lumbar spine.

-Only those with one or two-level surgeries.

▶Evaluation method:

1. Clinical chart and radiologic reviews

2. fusion solidity assessed

3. functional outcomes:

·SF-36(pre, post op)

·Oswestry Disability Index (ODI)

·Satisfaction questionnaire

-The minimum follow-up period: 24 months.

Results

1. Operating Time, hospital stay: less in the TLIF group.

2. Blood loss: slightly less in the TLIF group

3. Complications: Intra-operative- higher in the APF group (due to vein lacerations)

    Postoperative- higher in the TLIF group

    (due to graft material extruding against the nerve root or wound drainage)

4. The pseudarthrosis** rate: statistically equal

5. functional outcomes:

-SF-36: signifiicant improvements in both groups.

-Mean ODI scores: 33.5 (APF), 39.5 (TLIF group)

-Satisfaction rate: equal for the two groups.

Conclusion

-There are numerous, distinctive factors influencing results of each spinal fusion approach.

** pseudarthrosis: 위관절 혹은 가관절. -골절부의 뼈가 잘 유합되지 않아 마치 관절처럼 움직이는 상태. 골절 후 골 고정이 잘못 되거나, 골절부가 세균에 감염되었을 때 발생한다.

Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.

Brief review

*Title: Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.

외래환자의 신경공경유요추체유합술 시행 가능성에 대한 예비결과

*Author: Alan T. Villavicencio, Ewell Lee Nelson, Alexander Mason, Sharad Rajpal, Sigita Burneikiene

*Bibliography: JSpinal Disord Tech. 2013 Aug;26(6):298-304

STUDY DESIGN: A retrospective chart review study

OBJECTIVE:

-The primary objective: To examine whether it is safe and effective to perform instrumented lumbar interbody fusions by comparing 2 groups (same day vs stayed overnight).

-The secondary objective: To identify the need for prolonged observation for complications that may occur in the immediate postoperative period.

SUMMARY OF BACKGROUND DATA: 

There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting.

METHODS:

▶Subject number: Ambulatory Surgery Center(ASC): 27/  Hospital Outpatient Departments (HOD): 25

▶Mean age: 49.8 years (19-72 y)

▶evaluation method:

-The safety of outpatient lumbar fusions: analyzing complications that occurred when the seventh postoperative day (0-7 POD).

- The efficacy of surgical intervention: change in pain, patient satisfaction scores, and fusion rates

RESULTS:

-no cases of pneumonia, urinary tract infection, or thromboembolic complications.

-4 patients(14%) in ASC and 1 patient(4%) in HOD had complications within 7 days postoperatively.

-->not statistically significant in difference (P=0.36, Fisher exact test).

-Lower back and leg pain was significantly (P<0.0001) decreased postoperatively as follow.

>The average back pain: 74.5 (range: 0-100)  --> 18.8 (range: 0-90)

>The average leg pain: 54.2 (range, 0-100) --> 9.1 (range, 0-60)

*using 0-100 visual analog scale

CONCLUSIONS: 

This study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure.