Direct Lumbar Interbody Fusion Research Articles

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

A radiographic analysis of cage positioning in lateral transpsoas lumbar interbody fusion

Direct Lumbar Interbody Fusion (DLIF) and eXtreme Lateral Interbody Fusion (XLIF) are the most common surgical platforms available for performing transpsoas spinal fusion but no study has been carried out to compare them. We evaluated 21 DLIF and 22 XLIF cage positions by measuring the distance between the posterior vertebral border and the centre of the cage normalised to the midsagittal length of the inferior end plate. We found that DLIF cages were significantly more anteriorly located than XLIF (0.65 vs 0.52, p=0.001) at L4-5, suggesting that XLIF would permit implantation of wider cages than DLIF.

Direct lateral lumbar interbody fusion: clinical and radiological outcomes.

ObjectiveAccording to the recent development of minimally invasive spinal surgery, direct lumbar interbody fusion (DLIF) was introduced as an effective option to treat lumbar degenerative diseases. However, comprehensive results of DLIF have not been reported in Korea yet. The object of this study is to summarize radiological and clinical outcomes of our DLIF experience.MethodsWe performed DLIF for 130 patients from May 2011 to June 2013. Among them, 90 patients, who could be followed up for more than 6 months, were analyzed retrospectively. Clinical outcomes were compared using visual analog scale (VAS) score and Oswestry Disability Index (ODI). Bilateral foramen areas, disc height, segmental coronal and sagittal angle, and regional sagittal angle were measured. Additionally, fusion rate was assessed.ResultsA total of 90 patients, 116 levels, were underwent DLIF. The VAS and ODI improved statistically significant after surgery. All the approaches for DLIF were done on the left side. The left and right side foramen area changed from 99.5 mm2 and 102.9 mm2 to 159.2 mm2 and 151.2 mm2 postoperatively (p<0.001). Pre- and postoperative segmental coronal and sagittal angles changed statistically significant from 4.1° and 9.9° to 1.1° and 11.1°. Fusion rates of 6 and 12 months were 60.9% and 87.8%. Complications occurred in 17 patients (18.9%). However, most of the complications were resolved within 2 months.ConclusionDLIF is not only effective for indirect decompression and deformity correction but also shows satisfactory mechanical stability and fusion rate.

Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion: clinical and radiological results.

ObjectiveThe use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes.MethodsA retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed.ResultsDLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p<0.001). As the extent of surgical level increased, DLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05).ConclusionBoth DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach.

Mini-open approach for direct lateral lumbar interbody fusion.

Study DesignRetrospective analysis.PurposesTo introduce the mini-open lateral approach for the anterior lumbar interbody fusion (ALIF), and to investigate the advantages, technical pitfalls and complications by providing basic knowledge on extreme lateral interbody fusion (XLIF) or direct lumbar interbody fusion (DLIF).Overview of LiteratureRecently, minimally invasive lateral approach for the lumbar spine is revived and receiving popularity under the name of XLIF or DLIF by modification of mini-open method when using the sequential tubular dilator and special expandable retractor system.MethodsSeventy-four patients who underwent surgery by the mini-open lateral approach from September 2000 to April 2008 with various disease entities were included. Blood losses, operation times, incision sizes, postoperative time to mobilization, length of hospital stays, technical problems and complications were all analyzed.ResultsThe blood losses and operation times of patients who underwent simple ALIF were 61.2 mL and 86 minutes for one level, 107 mL and 106 minutes for two levels, 250 mL and 142.8 minutes for three levels, and 400 mL and 190 minutes for four levels of fusion. The incision sizes were on average 4.5 cm for one level, 6.3 cm for two levels, 8.5 cm for three levels and 10.0 cm for four levels of fusion. The complications were retroperitoneal hematoma (2 cases), pneumonia (1 case) and transient lumbosacral plexus palsy (3 cases).ConclusionsTrials of mini-open lateral approach would be helpful before the trial of XLIF or DLIF. However, special attention is required for complications such as transient lumbosacral plexus palsy.