Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability.

Brief review 2

*Title: Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability.

*Authors: Alan T. Villavicencio, MD,  Sigita Burneikiene, MD,  Ketan R. Bulsara, MD,  Jeffrey J. Thramann, MD

*Bibliography: J Spinal Disord Tech. 2006Apr;19(2):92-7.

OBJECTIVES: 

To assess clinical parameters for TLIF and AP reconstructive surgery for lumbar fusion.

(clinical parameters: 1)surgical blood loss, 2)duration of the procedure, 3)length of 

hospitalization, 4)complications)

METHODS: retrospective analysis -chart review (2002.01~2004.03)

▶Subject number: Total 167 cases

-TLIF: 124 patients (73 minimally invasive + 51 open cases) & AP surgery: 43 patients

▶Indications: 

-painful degenerative disc disease

-facet arthropathy

-degenerative instability

-spinal stenosis

-degenerative spondylolisthesis.

RESULTS:

1)blood loss, 2)operative times, 3)hospitalization times are listed belows.

 >OR Time: OpeRation Time

   EBL: Estimated Blood Loss

   LOS: Length Of Stay

4)complication rate are as follows.

-Major Complications

-Minor Complications

CONCLUSIONS:

1)blood loss : AP lumbar interbody fusion (significantly increased) > TLIF 

2)operative times: AP lumbar interbody fusion (more longer) > TLIF

3)hospitalization times: AP lumbar interbody fusion (more longer) > TLIF

4)complication rate: AP lumbar interbody fusion (more than 2 times higher) > TLIF

Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation

3rd journal review

*Title: Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation.

*Author: Jin-Sung Kim, MD,  Byung-Uk Kang, MD,  Sang-Ho Lee, MD, PhD,  Byungjoo Jung, MD, PhD,  Young-Gun Choi, MD,  Sang Hyeop Jeon, MD  Ho Yeon Lee, MD, PhD 

*Bibliography: J Spinal Disord Tech. 2009 Apr;22(2):114-21.

Study Design: Retrospective clinical data analysis.

Objective: To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis.

Summary of Background Data: There is clear evidence that comparing ALIF versus PLIF.

However, there are no recent studies that compare these 2 fusion techniques(ALIF and TLIF).

Methods: 
>Patient population
-patient characteristics (2004.03~2004.12)

-inclusion criteria

1) presence of single-level low-grade isthmic spondylolisthesis

2) chronic and persistent radiculopathy despite conservative treatment

3) progressive neurologic deficits

4) persistent and unremitting lower-back pain for more than 6months

5) loss of quality of life because of neurologic claudication

6) minimum follow-up period 2years

7) age range of 18 to 65 years

-exclusion criteria

1) previous spine surgery

2) concomitant scoliosis of more than 15 degrees

3) compression fracture or instability at the adjacent segment

4) underwent simultaneous decompression at adjacent segments

>Outcome assessment

-Radiologic outcome:

evaluated on anteroposterior, lateral, and flexion-extension radiographs.

 Radiologic data: 1)disc height 2) segmental lordosis 3) whole lumbar lordosis 4) degree of listhesis

<radiologic measurement method>

 Clinical outcome: 1) VAS(visual analog scale) 2) ODI(oswestry disability index)

>Surgical Techniques

-All ALIF procedures were performed using the mini-laparotomic retroperitoneal approach.

>Mini-TLIF with PPF

>Statistical Analysis

-An analysis of variance was conducted using the 2 proportions test, independent 2 sample t test, x^test, paired t test. (p<0.05)

Results

>Radiologic results

The postoperative radiologic data revealed below.

-DH and SL -->  significant difference
-degree of listhesis and WL--> Not  significant difference


>Clinical outcomes
-VAS score
ALIF- back: 7.7 --> 2.9
        leg:    7.5--> 2.7
TLIF- back: 7.0 --> 2.3
        leg:    6.3--> 2.2

-ODI score
ALIF: 51.4%--> 23.2%
TLIF: 52%   --> 14.4%


Conclusions
-The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. 

-However, clinical and functional outcomes did not demonstrate significant differences between groups.

Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?

1st journal review

*Title: Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?

*Author: Sheng-Dan Jiang, Jiang-Wei Chen, Lei-Sheng Jiang

*Bibliography: Arch Orthop Trauma Surg (2012) 132:1259-1266

Abstract
Introduction: This systematic review investigated whether surgical complications, non fusion rate, radiographic outcome and clinical outcome of ALIF were significantly different from those of TLIF.


Method: using MEDLINE data base.
>Eligibility criteria
selecting those articles: 1) target population, individuals: with lumbar spondylosis
2) intervention: ALIF compared with TLIF
3) English written article
and only the most recent papers were used..

>Identification of study
-Publications comparing ALIF and TLIF in the management of lumbar spondylosis were identified from a MEDLINE search. (1966.1~2011.6)
-using OVID search engine
-keyword: ALIF, TLIF, lumbar spondylosis

>Review method : Two authors reviewed the article using below method
1) review the title --> the article might meet eligibility criteria? -->2) then abstract review
-->3) review the complete article.
(only review the method section and blinded with author, institution, journal, results.)

>Statistical analysis
-using SPSS, unpaired Student's t test, Mann-Whitney U test/ Chi-squared test. ( p < 0.05 )


Result
-9 studies(comparing ALIF and TLIF) included in this systematic review.

1) Operative Time (7 studies)
ALIF >>>>>> TLIF

 2) Blood loss (7 studies)
ALIF >>>>>> TLIF

3) Complications (5 studies)
ALIF: 60 complications /244 patients
TLIF: 90 complications /371 patients

4) Radiographic outcomes: disc height, segmental lordosis, whole lumbar lordosis (3 studies)
ALIF >> TLIF

5) Clinical outcomes: using VAS(visual analog scale), ODI (oswestry disability index) (3 studies)
no significant difference

6) Nonfusion
ALIF: 23 /169 patients (13.6%)
TLIF: 23 /222 patients (10.4%)
no significant difference

7) Economic analysis
costs of ALIF were greater than those of TLIF.


Conclusion
OP Time and Blood loss, Radiographic outcomes, costs : ALIF > TLIF
Clinical outcomes and Nonfusion rate: ALIF ≒ TLIF