Posterior Lumbar Interbody Fusion Research Articles

18F-fluoride PET/CT as an early predictor of bony fusion after posterior lumbar interbody fusion– a prospective study

PurposePosterior Lumbar Interbody Fusion (PLIF) is a surgical procedure in which stabilization of spinal segments is achieved by inserting interbody cages filled with bone graft. Positron Emission Tomography (PET) is an imaging modality to assess physiological processes at cellular level, well before manifestation of morphological changes on computed tomography (CT). The goal was to determine whether 18F-fluoride PET/CT findings six weeks after PLIF, can predict bony fusion one year postoperatively on CT.Materials and methods20 consecutive PLIF patients (21 levels) were prospectively included. Based on diagnostic CT one year postoperatively, operated segments were classified as pseudarthrotic or fused. 18F-fluoride PET/CT scanning was performed at six weeks and one year, yielding parameters related to overall bone metabolism, bone blood flow and bone mineral incorporation. Differences in PET parameters between groups and follow-up moments were assessed. The area under the curve from the receiver operating characteristic was calculated for each PET parameter as a measure of diagnostic accuracy.Results11 segments were classified as pseudarthrotic and 10 as fused. Pseudarthrotic segments showed lower intervertebral overall bone metabolism values compared to fused segments at six weeks. Pseudarthrotic segments showed lower intervertebral bone blood flow at six weeks and lower intervertebral bone mineral incorporation at one year compared to fused segments. Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting the fusion status at one year.Conclusions18F-fluoride PET/CT six weeks after PLIF provides prognostic information on bony fusion at one year.

Biomechanical evaluation of oblique lateral interbody fusion with various fixation methods for degenerative lumbar scoliosis: a finite element analysis considering different bone densities

BackgroundFew studies have been conducted on the biomechanical stability of oblique lumbar interbody fusion (OLIF) in conjunction with different fixation methods in patients with degenerative lumbar scoliosis (DLS) at varying bone densities. This study uses finite element analysis to assess the biomechanical stability of OLIF with various fixation techniques for treating DLS under differing bone densities.MethodsA three-dimensional finite element model of the lumbar spine (L1-S1) was created using CT scans from a Lenke-Silva IV DLS patient. The control group consisted of a posterior lumbar interbody fusion (PLIF) model. The experimental groups included OLIF Stand Alone (OLIF-SA), OLIF combined with unilateral pedicle screw fixation (UPSF), and OLIF combined with bilateral pedicle screw fixation (BPSF) models. Three bone density conditions—normal bone mass (NBM), osteopenia, and osteoporosis—were used to evaluate these models. The range of motion (ROM) of the surgical segment, the stress distribution of the Cage, endplate, and internal fixation, as well as the peak Von Mises stress, were evaluated by applying a vertical downward load of 400N and a torque of 7.5N·m in different directions.ResultsUnder different bone densities, compared to the PLIF model, the ROM of the surgical segment in the OLIF-SA model was significantly increased, whereas the ROM in the OLIF-UPSF and OLIF-BPSF models was similar to or lower than that of the PLIF. Under NBM and osteopenia, both OLIF-UPSF and OLIF-BPSF effectively reduced the peak Von Mises stress on the endplate and maintained surgical segment stability. However, under osteoporosis, the peak Von Mises stress on the endplate in the OLIF-UPSF model approached or exceeded the maximum yield stress of the endplate (60 MPa) in certain motion states, while OLIF-BPSF demonstrated superior biomechanical stability. Additionally, variations in bone density significantly affected the stress distribution of internal fixation devices, with more uniform stress observed in the OLIF-BPSF model under osteoporosis conditions.ConclusionOLIF-BPSF may provide the best biomechanical stability for patients with DLS, especially osteoporosis patients. However, in patients with NBM and osteopenia, OLIF-UPSF remains an effective treatment option, which can ensure good biomechanical stability while obtaining significant minimally invasive advantages.

Is Intraoperative Neuromonitoring with SSEPs and EMG Predictable for Postoperative Neurologic Deficit in Posterior Lumbar Fusion Surgery? A Retrospective Cohort Analysis.

Study DesignRetrospective, single-center cohort study.ObjectiveTo evaluate intraoperative neuromonitoring (IONM) with free-run electromyography (EMG) and somatosensory evoked potentials (SSEPs) during primary posterior lumbar interbody fusion (PLIF) for degenerative conditions and associations with postoperative motor deficits (PMD).MethodsPatients undergoing PLIF from 2015 to 2020 were reviewed. Revision fusions, deformity corrections, and procedures in proximity to the conus were excluded. Patient characteristics, comorbidities, surgical details and intraoperative EMG and SSEP recordings were reevaluated. PMDs were defined as any decline of ≥1/5 strength grade compared to preoperative. Test accuracy and predictive value of SSEP and EMG events for PMD were calculated.Results401 patients (48.9% females, mean age 61 years, mean BMI 28.6) were included. One- and two-level fusions accounted for 67.8% and 27.7% of cases, respectively, most commonly involving L4/5 (67.8%) and L5/S1 (51.4%). EMG events occurred in 29.4% (n = 118) and SSEP events in 4.5% (n = 18). SSEP events were significantly associated with PMD (P = 0.043), whereas EMG events were not (P = 0.463). In multivariable regression, SSEP events predicted PMD with odds ratios of 3.85 for any SSEP event and OR 10.41 for persistent SSEP signal loss (both P = 0.002). Test performance of SSEP was limited (sensitivity: 13.6%; positive predictive value 16.7%).ConclusionIn posterior lumbar interbody fusion, SSEP events are associated with postoperative motor deficits, whereas EMG events are not. However, the overall test accuracy of IONM in predicting neurologic deficits remains limited. Instead of routine utilization, IONM should be tailored to the individual case.

Development and Validation of Interpretable Machine Learning Models Incorporating Paraspinal Muscle Quality to Predict Cage Subsidence Risk Following Posterior Lumbar Interbody Fusion.

A real-world, multicenter retrospective study. To identify independent risk factors for cage subsidence following Posterior Lumbar Interbody Fusion (PLIF) and develop an interpretable machine learning model for risk prediction. Patients with degenerative lumbar disease who underwent single-level PLIF (January 2018-October 2023) were retrospectively included. A training set (n=620) came from the First Affiliated Hospital of Soochow University, and a validation set (n=100) from the Second Affiliated Hospital. Cage subsidence (≥2mm intervertebral height loss) was assessed radiographically. Parameters included paraspinal muscle indices (Psoas Muscle Index [PMI], Multifidus Muscle Index [MM]), Fat Infiltration [FI]), bone density markers (Hounsfield Unit [HU] value, Vertebral Bone Quality [VBQ], Endplate Bone Quality [EBQ]), cage position, and postoperative alignment. Multivariate logistic regression identified risk factors; multiple machine learning models were developed and evaluated. A web-based tool was created for clinical deployment. Multivariate analysis identified PMI, FI, HU value, VBQ, cage position, cage height, postoperative Intervertebral Height (IH), corrected IH, and corrected SA as independent risk factors for cage subsidence. Light Gradient Boosting Machine (LightGBM) outperformed other models, achieving the highest AUC (0.9752), accuracy (0.92), and F1-score (0.9216), with the lowest Brier score (0.0660). After excluding indicators related to paravertebral muscle function from the prediction model, the predictive accuracy of the model decreased substantially. (SHapley Additive exPlanations) SHAP analysis confirmed VBQ, PMI, BMI, and EBQ as the most influential predictors. The final model was deployed as a web-based tool for real-time clinical risk assessment. Key risk factors for PLIF cage subsidence were identified, and a validated machine learning model was developed. The high-performance LightGBM model, deployed in a user-friendly web application, enables spine surgeons to optimize surgical planning and reduce subsidence risk.

Clinical value of fat depositions in different lumbar areas on spine degeneration and clinical outcomes.

This study aimed to compare the distribution characteristics and clinical values of the intramuscular, epimuscular and subcutaneous fat depositions in lumbar areas in lumbar spinal stenosis (LSS) patients and healthy controls. The study retrospectively reviewed 236 LSS patients undergoing posterior lumbar interbody fusion with follow-up visits. We also recruited 115 healthy controls from the community. All participants had undergone magnetic resonance imaging for the measurements of fat infiltration (FI) of the intramuscular fat and epimuscular fat of paraspinal extensor muscles (PEM, including multifidus [MF] and erector spinae [ES]), and subcutaneous fat tissue thickness. The evaluation of lumbar degeneration changes included intervertebral disk degeneration (IVDD) and Modic changes in healthy controls. Postoperative mechanical complications were measured at 1-year follow-up in LSS patients. The LSS patients presented with significantly higher intramuscular FI and epimuscular FI when compared with the healthy controls (p < 0.001). The severe IVDD group exhibited significantly higher epimuscular FI than the mild-to-moderate IVDD group (p < 0.01), and the Modic group exhibited significantly higher intramuscular FI (p < 0.05). In terms of clinical outcomes, the patients with mechanical complications presented with higher intramuscular FI (p < 0.05). In binary logistic regressions, the epimuscular FI was an independent factor of IVDD (OR = 1.209 [1.048-1.395], p = 0.009) for LSS patients, and the intramuscular FI was an independent factor of mechanical complications (OR = 1.053 [1.017-1.090], p < 0.001). The fat depositions in different lumbar areas might have specific distribution characteristics and different correlations to lumbar degenerative changes and clinical outcomes. Orthopedists should measure fat depositions in different lumbar areas separately during preoperative evaluation.

Impact of Sagittal Spinal Balance on Functional Recovery After PLIF of L5-S1 Isthmic Spondylolisthesis With Lumbar Spinal Stenosis.

Despite the widespread use of posterior lumbar interbody fusion (PLIF) for L5-S1 isthmic spondylolisthesis (IS) with lumbar spinal stenosis (LSS), residual sagittal imbalance critically impairs long-term pain relief and functional recovery. This study analyzes the influence of residual sagittal imbalanceon health-related quality of life (HRQOL) after PLIF for L5-S1 IS with LSS, aiming to optimize surgical correction and prognostic accuracy. This study analyzed 103 consecutive patients with L5-S1 IS and LSS undergoing PLIF from 2020 to 2022, followed at 3 days, 3 months, and ≥ 1 year postoperatively, using SPSS 26.0 for statistical analysis. Preoperatively, patients were stratified into balanced (SVA ≤ 50 mm) and unbalanced (SVA > 50 mm) groups. Postoperatively, the unbalanced group was reclassified into postoperative balanced (SVA ≤ 50 mm) and postoperative unbalanced (SVA > 50 mm) groups. Spinal parameters-including SVA, slip degree (SD), disc height (HOD), lumbar lordosis (LL), pelvic tilt (PT), and pelvic incidence (PI)-and clinical outcomes (Oswestry Disability Index [ODI], Visual Analogue Scale [VAS]) were analyzed preoperatively and postoperatively to assess surgical efficacy. Postoperative unbalanced group. In the balanced and unbalanced groups, SD and HOD significantly improved postoperatively versus preoperative values (p < 0.05). The balanced group showed no postoperative changes in SVA, LL, or PT (p > 0.05), while the unbalanced group exhibited marked improvements in these parameters (p < 0.05). At final follow-up, the balanced group maintained superior SVA, SD, HOD, LL, and PT compared to the unbalanced group (p < 0.05). Among the unbalanced group, postoperative balanced and unbalanced groups demonstrated significant improvements in SVA, SD, HOD, and PT (p < 0.05). However, LL remained unchanged in the postoperative unbalanced group (p > 0.05), whereas it improved in the postoperative balanced group (p < 0.05). The postoperative balanced group also achieved better SVA, SD, HOD, LL, and PT outcomes versus the postoperative unbalanced group (p < 0.05). ODI and VAS scores improved across all groups postoperatively, with the balanced group and postoperative balanced group outperforming their counterparts at final follow-up (p < 0.05). Preoperative and postoperative sagittal balance are pivotal determinants of long-term functional recovery and HRQOL in patients undergoing PLIF for L5-S1 IS with LSS.

Orthostatic Intolerance Following Posterior Lumbar Interbody Fusion: Incidence, Risk Factors, and Impact on Postoperative Recovery - A Prospective Cohort Study.

Orthostatic Intolerance Following Posterior Lumbar Interbody Fusion: Incidence, Risk Factors, and Impact on Postoperative Recovery - A Prospective Cohort Study.

Examination of clinical and radiographic outcomes after lumbar interbody fusion: a retrospective analysis of TLIF, MidLIF, and MIS-TLIF procedures.

Despite many available surgical techniques, the optimal method to achieve posterior lumbar interbody fusion (PLIF) is unclear. This study compares the efficacy of open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS-TLIF), and midline lumbar interbody fusion (MidLIF), based on patient-reported outcome measures and radiographic parameters. A retrospective review of a prospectively collected institutional spine quality database was performed to examine the medical records of patients who received a 1- or 2-level PLIF from January 2018 through April 2023. Quality of life (QOL) scores, including the Oswestry Disability Index (ODI), EuroQol 5-Dimension Index (EQ-5D), EuroQol visual analog scale (EQ-VAS), and numeric rating scale for back pain (NRS-BP) and leg pain (NRS-LP), were used to assess patient conditions at baseline, 3 months, and 12 months after surgery. These metrics, along with patient demographics, radiographic measurements, and surgical parameters, were analyzed and compared across the three treatment modalities. Of the 953 patients who met criteria, 81 (8.5%) underwent MidLIF, 108 (11.3%) underwent MIS-TLIF, and 764 (80.2%) underwent open TLIF. MIS-TLIF patients had significantly shorter hospital length of stay and less blood loss compared with MidLIF (both p < 0.001) and open TLIF patients (both p < 0.001). In patients with single-level fusion, open TLIF yielded significantly higher construct lordosis at 12 months postoperatively compared with MidLIF (p = 0.017), although average corrections to construct lordosis were similar across groups. Fusion rates were highest among the open TLIF group and were significantly higher (p < 0.01) than the MIS-TLIF group. Changes in QOL scores at the 3- and 12-month follow-ups were similar between procedure types, with the exception of NRS-LP at 3 months, which improved the most in the open TLIF cohort and was significantly higher than the MIS-TLIF cohort (p = 0.013). This analysis shows that MidLIF, MIS-TLIF, and open TLIF techniques all provide similar durable improvement in change from baseline ODI, EQ-5D, EQ-VAS, NRS-BP, and NRS-LP scores, as well as similar corrections to segmental lordosis. While open TLIF had the highest radiographic fusion rate, fusion rates were high among all groups. These findings provide insight on the variability of each technique, which can inform surgeons in determining the modality of treatment best suited for their patient's condition and needs.

Does Intraoperative Antiseptic Solution Soaking Reduce Microbial Contamination in Spine Surgery? A Randomized Controlled Trial.

Does Intraoperative Antiseptic Solution Soaking Reduce Microbial Contamination in Spine Surgery? A Randomized Controlled Trial.

A retrospective cohort study comparing perioperative clinical outcomes and radiographic results between patients undergoing TLIF and OLIF surgeries

PurposeTo investigate the perioperative outcomes, clinical manifestations, and radiographic indicators in patients who underwent oblique lateral lumbar fusion (OLIF) and posterior instrumentation, compared with those who underwent posterior transforaminal lumbar interbody fusion (TLIF) and instrumentation.MethodsIn this retrospective cohort analysis, elderly patients diagnosed with L4-5 lumbar spinal stenosis between July 2022 and July 2023 at our institution who underwent OLIF and posterior instrumentation (OLIF group), compared with those who underwent posterior TLIF and instrumentation (TLIF group). Enhanced Recovery After Surgery (ERAS) protocol was implemented for all patients. The perioperative data, patient-reported outcomes (PROs), radiographic assessments, and complications were gathered immediately after surgery and again at the 1-year follow-up. The perioperative outcomes and immediately postoperative and follow-up radiographic outcomes were compared between the two groups.ResultsA total of 120 patients participated in this study, with 60 patients assigned to the OLIF group and 60 to the TLIF group. With respect to outcomes, the length of stay was notably shorter in the OLIF group compared to the TLIF group (P < 0.001). Patients in the OLIF group exhibited significantly reduced postoperative drainage volume (P < 0.001), first ambulation on the postoperative day (POD) (P < 0.001), drain placement duration (P < 0.001), and urinary catheter retention (P = 0.037) compared to those in the TLIF group. Furthermore, there were statistically significant differences between the two groups in the incidence of postoperative deep venous thrombosis (DVT) (1 vs. 8, P = 0.015), urinary tract infection (2 vs. 11, P = 0.008), pulmonary infection (2 vs. 10, P = 0.015), and nausea and vomiting (3 vs. 11, P = 0.023). With respect to radiographic measurements, At the 1-year follow-up, the posterior disc height (PDH) and intervertebral disc angle (IDA) demonstrated statistically increase in the OLIF group. The sagittal vertical axis (SVA) was statistically decrease and Lumbosacral lordosis (LL) was statistically increase in the OLIF group.ConclusionOLIF was demonstrated to have significant advantages in terms of perioperative, clinical outcomes and radiographic parameters for L4-5 lumbar spinal stenosis for elderly patients, comapred with TLIF.

Comparative analysis of anterior lumbar interbody fusion and transforaminal lumbar interbody fusion in clinical outcomes: ALIF associated with lower rates of adjacent segment degeneration (ASD) in a long-term follow-up study.

To compare the long-term efficacy of anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) in treating lumbar degenerative diseases. A retrospective analysis was conducted on 57 patients with lumbar degenerative diseases who underwent either ALIF or TLIF from March 2003 to October 2007. Patients were divided into an ALIF group (n = 27) and a TLIF group (n = 30). Pain was evaluated using the visual analogue scale (VAS), and the Oswestry Disability Index (ODI) was used to assess clinical outcomes. Radiographic adjacent segment degeneration (rASD) was evaluated using the Modified Pfirrmann Scale. Three-dimensional CT was used to assess the fusion rate at the last follow-up. Follow-up duration ranged from 58 to 120 months, with an average of 90.6 months. No significant difference was observed in VAS and ODI scores between the two groups (P > 0.05). However, significant differences were noted before and after the operation (P < 0.05). The intervertebral disc height (IDH) and lumbar lordosis (LL) increased after the operation and during follow-ups. The IDH and LL in the ALIF group were significantly higher than those in the TLIF group both postoperatively and at follow-ups (P < 0.05). At the last follow-up, the incidence of rASD in the ALIF group was significantly lower than in the TLIF group (P < 0.05). Both ALIF and TLIF provide satisfactory long-term outcomes for lumbar degenerative diseases. ALIF more effectively restores and maintains lumbar intervertebral height and lumbar lordosis, potentially reducing the incidence of adjacent segment degeneration.

Clinical Outcomes of Revision Posterior Lumbar Interbody Fusion for Late Deterioration after Laminotomy Assessed with the Zurich Claudication Questionnaire.

A retrospective analysis of prospectively collected data. There have been a few studies comparing surgical outcomes between revision lumbar fusion surgery and the same primary surgery. Using the Zurich Claudication Questionnaire (ZCQ), we compared clinical outcomes of revision posterior lumbar interbody fusion (PLIF) for late deterioration after laminotomy with those of primary PLIF to examine whether surgical outcomes of revision PLIF for late deterioration after laminotomy are inferior to those of primary PLIF. Sixteen consecutive patients undergoing revision single-level PLIF for late deterioration after single-level laminotomy (R group) and 61 consecutive patients undergoing primary single-level PLIF during the same period (P group) were enrolled. Before PLIF surgery and at 2 years postoperatively, clinical outcomes were assessed using the ZCQ. Achievement rates of the minimum clinically important difference (MCID) of each domain (Symptom severity [SS] and Physical function [PF]) on the ZCQ were calculated in each group. In the R group, mean SS and PF before revision PLIF and at 2 years after surgery were 3.429 and 2.8, and 1.946 and 1.6, respectively. In the P group, mean SS and PF before primary PLIF and at postoperative 2 years were 3.438 and 2.5, and 2.194 and 1.6, respectively. Both SS and PF significantly improved at postoperative 2 years in both groups, and SS both before and after PLIF and PF at 2 years postoperatively showed no significant differences between the two groups. Achievement rates of the MCID of SS and PF were 81.3 and 68.8% in the R group, and 59.0 and 59.0% in the P group, respectively. None of the MCID achievement rates of SS and PF showed significant differences between the two groups. Clinical outcomes of revision PLIF for late deterioration after laminotomy were equivalent to those of primary PLIF assessed with the ZCQ at 2 years after PLIF surgery.

Comparison of Endoscopic Unilateral Laminectomy for Bilateral Decompression (Endo-ULBD) and Posterior Lumbar Interbody Fusion (PLIF) in Managing Multi-Segmental Lumbar Spinal Stenosis: Technique and Early Outcomes.

Lumbar spinal stenosis is a common degenerative spine condition that leads to severe pain and disability. Surgical intervention is often required when conservative treatments fail, but the choice between different surgical techniques remains a topic of ongoing debate. The objective of this study was to provide a comprehensive comparison of the safety and efficacy of endoscopic unilateral laminectomy with bilateral decompression (Endo-ULBD) and posterior lumbar interbody fusion (PLIF) in the treatment of multi-segmental lumbar spinal stenosis (MS-LSS). Furthermore, the text provides detailed technical information regarding the Endo-ULBD procedure. This retrospective comparative study was conducted from October 2019 to October 2022 and involved 73 patients diagnosed with MS-LSS. Of the total number of patients, 36 were treated with Endo-ULBD and 37 with PLIF. The technical parameters of both procedures were recorded, including perioperative factors such as patient demographic characteristics (age, gender, BMI), disease duration, number of surgical segments involved, type of anesthesia, duration of surgery, estimated blood loss (EBL), postoperative length of stay, time to discharge, use of intraoperative fluoroscopy, and any intraoperative complications. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), the Japanese Orthopedic Association (JOA) score, and the Oswestry Disability Index (ODI), which were assessed preoperatively and at follow-up. Radiologic improvement was quantified by comparing the preoperative and postoperative dural sac areas. Statistical analyses were conducted using paired t tests with a significance threshold of p < 0.05. In comparison to the PLIF group, the Endo-ULBD group exhibited a markedly shorter operative time, diminished intraoperative bleeding, accelerated recovery of ambulation, and a shorter postoperative hospitalization period. Moreover, the Endo-ULBD group demonstrated a diminished prevalence of postoperative complications. However, it required a significantly greater number of intraoperative x-ray fluoroscopies than the PLIF group (p < 0.05). Postoperative VAS, ODI, and JOA scores demonstrated notable improvement in both groups, with a more pronounced trajectory observed in the Endo-ULBD cohort during the early postoperative period. Both surgical approaches resulted in a notable enlargement of the dural sac area. Neither group experienced any fatalities, irreversible nerve damage, or paralysis. Endo-ULBD demonstrated superior early clinical outcomes compared to PLIF, including shorter operative time, reduced blood loss, faster recovery, and fewer complications. Both techniques provided similar improvements in dural sac decompression, but Endo-ULBD may offer a more efficient and minimally invasive treatment option for patients with MS-LSS. However, the high frequency of intraoperative fluoroscopy remains a limitation, highlighting the need for improved surgical techniques and positioning systems.

Safety and Viability of Anterior Lumbar Interbody Fusion in Complex Revision Lumbar Spine Surgeries: Insights From a Case Series of 135 Patients on Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion Cage Removal.

Anterior lumbar interbody fusion (ALIF) has emerged as a valuable technique for managing lumbar degenerative conditions and revision surgeries, particularly for addressing complications associated with transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) cages. However, there is limited evidence documenting its safety and feasibility in the context of revision procedures involving cage removal. To evaluate intraoperative outcomes of ALIF for TLIF/PLIF cage removal, focusing on complications, surgical times, and blood loss in a substantial case series. This case series analyzed data from 135 patients who underwent ALIF for TLIF/PLIF cage removal between January 2019 and May 2023. Surgical indications included pseudarthrosis, cage migration, and infection. Outcomes assessed included intraoperative complications, surgical duration, and estimated blood loss. Of the 135 patients (median age: 47 years, range: 15-78), vascular injuries occurred in only 4 cases, all involving the left iliac vein, and were managed intraoperatively without sequelae. No injuries to retroperitoneal, neural, or organ structures were observed. Median surgical time was 100 minutes (range: 50-210), with most cases resulting in less than 150 mL of blood loss. These findings demonstrate the feasibility of ALIF for managing TLIF/PLIF complications. ALIF is a safe and effective option for revision surgeries involving TLIF/PLIF cage removal, offering a low complication profile and manageable intraoperative challenges. A critical factor contributing to these favorable outcomes is the multidisciplinary approach, where the collaboration between access and spine surgeons ensures meticulous handling of anatomical and vascular challenges. This study provides valuable data for further prospective research to explore long-term outcomes and refine surgical techniques.

Decoding the multifidus muscle: fat infiltration as a predictor of outcome after lumbar-lumbar fusion surgery.

Decoding the multifidus muscle: fat infiltration as a predictor of outcome after lumbar-lumbar fusion surgery.

Effect of cage surface geometry on load transfer and ranges of motion in a fused lumbar spine model: A comparative finite element analysis.

Lumbar degenerative disc diseases (DDDs) are the common causes of low back pain, leading to non-conservative treatments like fusion and non-fusion surgery as a last resort. Fusion surgery is the gold standard for addressing DDDs, where implants such as cages, pedicle screws and rods are used for posterior stabilization. Various finite element (FE) studies have reported using corrugated cage surface textures; some others have used flat textures for virtual implantation. No comparative studies have been reported on the biomechanical effects of fusion surgery under implantation with cages of varying surface textures. The present biomechanical study compares the mechanical behaviour of an L4-L5 segment implanted with cages of different surface textures. The surgical techniques used for implantation are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion. The virtual surgical models were developed from a previously validated intact lumbar spine FE model and simulated for physiological loading conditions. Compared to the flat cage implantation, a higher magnitude of stress was experienced by the cages and pedicle screw-rod systems under corrugated cage implantation. The maximum von Mises stress generated in the PLIF corrugated cage was 80.69% more than that observed in the flat cage. The maximum stresses in the corrugated cage were higher than those of the flat cage by 38.43%-80.69%, considering all the applied loading conditions. The findings of the study suggest that corrugated cage surface texture and suitable material selection may help in improving the long-term stability of cages.

Does incidental durotomy affect clinical outcome in patients with lumbar degenerative diseases after posterior open lumbar interbody fusion? a multicenter observational study

BackgroundIncidental durotomy (ID) during spinal surgery is common during spinal surgery. This study aimed to determine whether intraoperative ID affects the perioperative and long-term clinical outcomes in patients with degenerative lumbar disease (DLD) undergoing posterior open lumbar interbody fusion (POLIF).MethodsThis multicenter observational study was conducted at two spinal centers between January 2020 and December 2022. The patients were divided into ID and non-ID groups according to whether ID occurred intraoperatively. Primary outcome measure was the length of hospital stay (LOS), while secondary outcome measures were 30-day readmission rate; hospital costs; postoperative visual analog scale (VAS) scores for low back pain (LBP) and leg pain (LP) at 1 day, 3, 7, and 15 days, 1 month, 3, 6, and 12 months; and Oswestry Disability Index (ODI) at 1 month, 3, 6, and 12 months.ResultsIntraoperative ID occurred in 8.7% (36/415) patients. LOS, operative time, estimated blood loss, 30-day readmission rate, and hospital costs were significantly higher in the ID group. On average, the LOS increased by 2.9 days and hospital costs increased by 4800.2 yuan per patient. The ID group had significantly higher baseline VAS scores for LBP 15 days and 1 month postoperatively than the non-ID group. The ODI was significantly higher in the ID group than in the non-ID group 1 month postoperatively. No significant differences were noted in the VAS scores and ODI between the two groups at 3, 6, and 12 months postoperatively. Finally, we found that a higher BMI (P = 0.035, OR: 1.195, 95%CI: 1.012–1.412) and revision surgery (P = 0.022, OR: 2.901, 95%CI: 1.164–7.233) were risk factors for intraoperative ID.ConclusionsAlthough ID does not significantly affect the long-term outcomes in patients with DLD after POLIF, it can lead to poorer perioperative clinical outcomes. Lumbar fusion surgery should be performed meticulously to minimize the incidence of intraoperative ID.

Posterior lumbar interbody fusion with single cage and bonegraft substitute for the management of spondylolisthesis: A prospective study

Posterior lumbar interbody fusion with single cage and bonegraft substitute for the management of spondylolisthesis: A prospective study

Spinal morphological change after posterior lumbar interbody fusion in lumbar spondylolisthesis patients.

Lumbar spondylolisthesis is a degenerative status in the spine. Posterior lumbar interbody fusion (PLIF) with instrumentation has considered as the standard surgical treatment for lumbar instability. Spinal canal and dural sac cross-sectional area (CSA) has been major parameters for evaluating neurologic symptoms. This study is aimed at finding the radiological change using the dural sac CSA and spinal canal CSA as an objective morphological parameter after PLIF. Of the 74 patients (24 men, 50 women; mean age 66.49 years) who had PLIF surgery were checked for preoperative magnetic resonance imaging (MRI) and MRI within 1 week after surgery. T2-weighted axial MRI scans were obtained from each patient. We measured the dural sac and spinal canal CSA on an axial MRI image at the center of L4 to L5 intervertebral disc. The average spinal canal CSA was 70.28 ± 27.77 mm2 in the preoperative MR images and 149.59 ± 35.20 mm2 in the postoperative MR images. The average dural sac CSA was 42.46 ± 18.49 mm2 in the preoperative MR images and 98.93 ± 29.32 mm2 in the postoperative MR images. After the PLIF operation, the mean spinal canal CSA was 112.84 percent increase, and the measn dural sac CSA was 132.99 percent increase. After PLIF, patients had significantly higher dural sac CSA (P < .001) and spinal canal CSA (P < .001). Spinal canal CSA have increased by 112.84 percent and Dural sac CSA have increased by 132.99 percent after PLIF. Thus, before PLIF, the treating physician should carefully explain this result to patient.

The impact of obstructive sleep apnea on early surgical site infections in elderly PLIF patients: a retrospective propensity score-matched analysis

BackgroundObstructive sleep apnea (OSA) is a prevalent sleep disorder associated with intermittent hypoxia, oxidative stress, and systemic inflammation, posing risks for adverse postoperative outcomes, including surgical site infections (SSIs). Elderly patients undergoing posterior lumbar interbody fusion (PLIF) are particularly susceptible to SSIs due to advanced age, comorbidities, and prolonged surgical times. However, the role of OSA in increasing SSI risk among this population remains unclear.MethodsThis retrospective cohort study analyzed 478 elderly PLIF patients from a single institution between May 2016 and June 2024. Of these, 113 were diagnosed with OSA. Propensity score matching (PSM) was performed to balance baseline characteristics, resulting in 83 matched pairs. SSI rates, hospital stays, and readmission rates were compared between the OSA and non-OSA groups. Subgroup analysis was conducted to evaluate the effects of continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) therapy on postoperative outcomes.ResultsAfter PSM, OSA patients demonstrated a significantly higher SSI incidence (13.3% vs. 3.6%, p = 0.04) compared to non-OSA patients. On multivariate analysis, OSA was the only factor that remained significantly associated with an increased risk of SSIs (Odds Ratio = 4.509, 95% CI: 1.283–21.504, p = 0.03). OSA patients also experienced longer hospital stays (10.1 ± 2.9 vs. 9.1 ± 2.0 days, p = 0.01) and elevated 30-day readmission rates (9.6% vs. 1.2%, p = 0.02). Subgroup analysis revealed that CPAP/APAP therapy reduced SSI incidence (3.9% vs. 17.5%, p = 0.08) and shortened hospital stays (9.1 ± 1.5 vs. 10.5 ± 3.2 days, p = 0.03) among OSA patients.ConclusionOSA significantly increases the risk of early SSIs and prolongs hospital stays in elderly PLIF patients. Subgroup analysis suggests that CPAP/APAP therapy may have benefits to OSA patients, though this association requires validation through prospective studies. These findings emphasize the importance of preoperative OSA screening and management to improve surgical outcomes in this high-risk population.