Treatment Of Lumbar Degenerative Disease Research Articles

Application of oblique lateral interbody fusion in the degenerative lumbar disease

Objective To investigate the operation key points and clinical efficacy of oblique lateral interbody fusion (OLIF) for the treatment of degenerative lumbar disease. Methods The clinical data of 22 patients with degenerative lumbar disease treated with OLIF at the Department of Neurosurgery, Sichuan Provincial People’s Hospital from December 2014 to October 2015 were analyzed retrospectively. Eight patients were treated with the combined posterior percutaneous pedicle screw fixation, 11 were treated with the combined anterior percutaneous pedicle screw fixation, and 3 did not treated with the screw-rod system fixation. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and imaging findings before and after procedure were compared. The clinical efficacy of the surgical method was evaluated. The follow-up time ranged from 3 to 9 months (mean, 6.6 months). Results Postoperative VAS score (2.73±0.84) and ODI score (20.97±3.83) were significantly decreased compared with before procedure (VAS score: 7.10±0.97; ODI score: 60.86±6.88; all P<0.05). The average operation time was 92.5±14.8 min, the average blood loss was 78.4±29.6 ml, and the average length of stay was 8.2±2.4 d. Compared with before procedure, the postoperative intervertebral space height was increased (after procedure: 9.12±1.09 mm, before procedure: 5.24±1.07 mm, P<0.001) and the intervertebral foramen area was increased in 22 cases (after procedure: 1.81±0.25 cm2, before procedure: 0.83±0.10 cm2, P<0.001). None of them had severe complications, such as vascular injury, lumbar plexus nerve injury, ureteral injury and infection. Conclusions OLIF is a safe, effective, and minimally invasive surgical method for the treatment of lumbar degenerative disease. Its clinical efficacy is reliable in the near future. It has the advantages of short operation time, less intraoperative blood loss, less trauma, and quick recovery. Strict selection of patients and grasping the technical details are the keys to the success of surgery. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Surgical procedures, minimally invasive; Oblique lateral interbody fusion

Influence of isobar ttl dynamic internal fixation system on adjacent segment degeneration by mri measurement of lumbar nucleus pulposus volume

?To investigate the influence of ISOBAR TTL dynamic internal fixation system on degeneration of adjacent intervertebral disc by MRI measurement of lumbar nucleus pulposus volume in treating lumbar degenerative disease after operation. ?Between March 2010 and October 2011, 34 patients with lumbar intervertebral disc herniation (23 cases of paracentral type and 11 cases of lateral type) underwent operation with ISOBAR TTL dynamic internal fixation system for fixation of single segment, and the clinical data were analyzed retrospectively. There were 20 males and 14 females, aged 39-62 years (mean, 47.5 years). The disease duration was 6-18 months (mean, 14 months). Involved segments included L4, 5 in 21 cases and L5, S1 in 13 cases. The X-ray films and MRI images were taken at 6, 12, 18, 24, 36, and 48 months after surgery. Based on X-ray films, the height of intervertebral space was measured using angle bisectrix method. The nucleus pulposus volume was measured based on the MRI scan. The postoperative change of nucleus pulposus volume and intervertebral disc height were used to evaluate the influence of ISOBAR TTL system on degeneration of adjacent intervertebral disc nucleus pulposus. ?Thirty patients were followed up 48 months. The height of intervertebral space showed no significant difference between at pre-and post-operation (P>0.05). The nucleus pulposus volume increased after operation, showing no significant difference at 6, 12, and 18 months when compared with preoperative value (P>0.05), but significant difference was found at 24, 36, and 48 months when compared with preoperative value (P<0.05). The height of nucleus pulposus increased after operation but the width was decreased; the values showed no significant difference at 6, 12, and 18 months when compared with preoperative ones, but showed significant difference at 24, 36, and 48 months when compared with preoperative ones (P<0.05). The diameter of nucleus pulposus at 18, 24, 36, and 48 months after operation was significantly langer than that at preoperation (P<0.05). ?ISOBAR TTL dynamic internal fixation system can prevent or delay the degeneration of intervertebral discs.

APPLICATION OF DIRECT LATERAL INTERBODY FUSION FOR LUMBAR DEGENERATIVE DISEASES

To investigate the effectiveness of direct lateral interbody fusion (DLIF) for lumbar degenerative diseases. A retrospective study was done on 25 cases of lumbar degenerative diseases treated with DLIF between May 2013 and May 2014. There were 15 males and 10 females with an average age of 61.4 years (range, 36-78 years), including 14 cases of lumbar disc herniation, 2 cases of degenerative lumbar scoliosis, 3 cases of lumbar spondylolisthesis, and 6 cases of lumbar instability with spinal stenosis. The disease duration was 8 months to 20 years (mean, 5.7 years). The involved segments included L4, 5 in 10 cases, L3, 4 in 6 cases, L2, 3 in 2 cases, L2-4 in 2 cases, L3-5 in 3 cases, and L2-5 in 2 cases. The operation time, intraoperative bleeding volume, postoperative hospitalization time, and complications were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) criteria were used to assess the effectiveness; X-ray film and CT were used to evaluate the bone fusion. The mean operation time was 105?minutes (range, 85-155 minutes), and mean intraoperative bleeding volume was 158 mL (range, 80-300?mL). The postoperative hospitalization time was 2-5 days (mean, 3.2 days). All incisions healed by first intension. There was no complication of wound infection, vascular injuries, or intraoperative visceral injuries. All cases were followed up 24.6 months on average (range, 18-30 months). Four cases had iliopsoas weakness, 5 cases had iliopsoas weakness and anterior thigh hypoesthesia, which disappeared within 6 months after operation. No retrograde ejaculation, Cage displacement, or loosening was found after operation. Full bony fusion was observed in 20 segments and partial bony fusion in 12 segments. The mean bony fusion time was 10.8 months (mean, 6-18 months). The height of intervertebral space was significantly increased to (11.98±1.20)?mm at 2 days after operation and to (11.80±1.33) mm at last follow-up from preoperative (6.20±0.88) mm (P &lt; 0.05), but no significant difference was found between at 2 days and last follow-up (P &gt; 0.05). At last follow-up, VAS score was significantly decreased to 3.43±0.53 from preoperative 8.26±0.49 (t=26.275, P=0.000), and ODI was significantly decreased to 15.41%±3.91% from preoperative 40.80%±3.10% (t=22.902, P=0.000). DLIF is a safe and effective treatment for lumbar degenerative diseases, which has the advantages of less tissue damage, less blood loss, and fast rehabilitation.

Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years.

The aim of this study was to assess the outcome of symptomatic lumbar degenerative disease treated with topping-off technique (Coflex(™) combined with fusion) and compare two-segment fusion at mid-long term follow-up; and find out whether the topping-off technique can reduce the rate of adjacent segment degeneration (ASD) after fusion. One hundred and fifty-four consecutive patients who received topping-off surgery (76 patients) and two-segment fusion surgery (88 patients) from March 2009 to March 2012 were studied. All patients included in the analysis had a minimum of threeyears of follow-up. Radiographic and clinical outcomes between the two groups were compared. A logistic regression analysis was used to analyze risk factors for developing radiographic ASD. Significant differences in clinical outcomes were observed between these two groups at three post-operative years (all, p < 0.05). Compared with the fusion group, the topping-off group showed preserved mobility at the Coflex(™) level (p = 0.000), which is associated with less blood loss (p = 0.000), shorter duration of surgery (p = 0.000) and lower incidence of ASD (Chi-square test, rate topping-off vs fusion = 13.2 vs 26.1%, p = 0.039). There were no differences in complications between the two groups. Mid-long term follow-up efficacy and safety between topping-off and fusion were similar, while topping-off reduced the rate of ASD. Under strict indications, topping-off surgery is an acceptable alternative to fusion surgery for the treatment of two-segment lumbar disease.

Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages.

This study reports the clinical effects of nano-hydroxyapatite/polyamide66 cages (n-HA/PA66 cages) and compares the clinical outcomes between n-HA/PA66 and polyetheretherketone cages (PEEK cages) for application in transforaminal lumbar interbody fusion (TLIF). A retrospective and case–control study involving 124 patients using n-HA/PA66 cages and 142 patients using PEEK cages was conducted. All patients underwent TLIF and had an average of 2-years of follow-up. The Oswestry Disability Index and Visual Analog Scale were selected to assess the pain of low back and leg, as well as neurological status. The intervertebral space height and segmental angle were also measured to estimate the radiological changes. At the 1-year and final follow-ups, the fusion and subsidence rates were evaluated. There was no significant difference between the two groups regarding clinical and radiological results. At the final follow-up, the bony fusion rate was 92.45 and 91.57 % for the n-HA/PA66 and PEEK groups, respectively, and the subsidence rate was 7.55 and 8.99 %, respectively. The study indicated that both n-HA/PA66 and PEEK cages could promote effective clinical and radiographic outcomes when used to treat degenerative lumbar diseases. The high fusion and low subsidence rates revealed that n-HA/PA66 cages could be an alternative ideal choice as the same to PEEK cages for lumbar reconstruction after TLIF.

Interpretation of "Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine (2014)"

Lumbar fusion procedures have become a necessary management strategy in the treatment of lumbar degenerative disease. The new version of the Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine was published by American Association of Neurological Surgeons (AANS) in 2014 since the first version had been published in 2005. Through comprehensive review of existing literatures, the new guideline analyzed current evidence of evidence-based medicine and formulated hierarchical recommendation grades from 16 topics which included assessment of functional outcome following lumbar fusion, assessment of economic outcome, radiographic assessment of fusion status, and so on, in order to provide clinical treatment guidance. This article interpreted the new guidelines summarily to help surgeons gain some understanding on it. DOI: 10.3969/j.issn.1672-6731.2016.04.002

LUMBAR SPINE SURGERY. IMPORTANCE OF SAGITTAL BALANCE IN THE QUALITY OF LIFE OF PATIENTS

ABSTRACT Objective: To evaluate whether performing surgery in degenerative diseases of the lumbar spine modify the spinopelvic balance and influences the clinical outcome and the quality of life of patients. Methods: The spinopelvic balance was evaluated in 25 patients using plain radiographs of the lumbosacral region including the proximal femur, as well as evaluating the quality of life on two separated occasions. Results: The measure of spinopelvic balance was obtained by averaging the angles of sacral slope, pelvic version and pelvic incidence. Mean preoperative angles were 59.88º, 22.84º, and 37.44º, respectively, and the mean postoperative values were 61.56º, 24.64º, and 37.32º, respectively. Regarding the questionnaires on quality of life, the Oswestry index showed mean preoperative values of 46.24, characterized as severe disability and mean postoperative values of 13.29 denoting satisfactory response after surgical treatment. The SF-36 questionnaire showed important and significant improvement in quality of life in different domains, with the exception of physical limitation and social aspects, with a p-value of 0.02 and 0.025, respectively. Conclusion: Patients undergoing surgical treatment of degenerative lumbar diseases showed no significant changes in the spinopelvic balance, but showed significant improvement in quality of life after surgery.

Non-fusion procedure using PEEK rod systems for lumbar degenerative diseases: clinical experience with a 2-year follow-up.

BackgroundPolyetheretherketone (PEEK) rod system is a novel pedicle-based dynamic stabilization system. This study evaluated clinical and radiographic outcomes of non-fusion surgery by PEEK rod systems for treatment of degenerative lumbar diseases with a 2-year follow-up.MethodsFrom February 2012 to October 2012, 38 patients who underwent non-fusion surgery using PEEK rod systems were included in the study. Data on Oswestry Disability Index (ODI) score and Japanese Orthopaedics Association (JOA) score were collected and radiographs were obtained to evaluate disc height index (DHI) and range of motion (ROM) at each interval.ResultsBoth JOA and ODI scores significantly improved postoperatively. DHI showed a slight increase immediately after the surgery but gradually dropped below preoperative levels. Mean ROM values changed from 8.8° preoperatively to 1.8° at the 2-year follow-up point. Screw loosening occurred in one case at the 2-year follow-up.ConclusionsThe preliminary results indicated a significant improvement in clinical outcomes and advantageous implant safety. The non-fusion procedure using PEEK rod systems might be a viable alternative for treatment of lumbar degenerative diseases. The distraction technique needs to be improved for better postoperative DHI.

Application of the Technique of &amp;quot;Mobile Skin and Soft Tissue Window&amp;quot; in Single Segment Lumbar Interbody Fusion

To investigate the surgical techniques and short-term clinical effects of minimally invasive lumbar interbody fusion in the treatment of lumbar degenerative diseases, 43 patients who underwent minimally invasive posterior lumbar interbody fusion from January 2012 to September 2014 were retrospectively reviewed. The lesion was located by C- arm fluoroscopy during the operation. The working areas for placing pedicle screw, fusion and decompression were well exposed by the technique of "mobile skin and soft tissue window". The operation time, intraoperative blood loss, length of incision, blood drainage and complication after operation were recorded. Oswestry disability index (ODI) and visual analogue scale (VAS) of pre-operation, 7 days, 1, 3 and 12 months postoperatively were evaluated. 37 patients were followed up for an average of 15.2 ± 4.7 months. Intraoperative blood loss was 175.1 ± 71.8 ml; operation time was 129.0 ± 12.0 min; length of incision was 5.4 ± 0.3 cm and postoperative blood drainage was 116.5 ± 66.0 ml. Postoperative lumbar and leg VAS and ODI scores were significantly decreased, comparing with that of pre-operation (P < 0.05). Lumbar VAS score was 6.6 ± 0.8 before operation and 0.7 ± 0.6 at 12-month follow-up. Leg VAS score was 7.0 ± 0.1 before operation and 0.6 ± 0.5 at 12-month follow-up. Average ODI percent was 68.6% ± 5.4% before operation and 6.2% ± 1.6% at 12-month follow-up. There were no internal fixation loose and fracture, and the radiographic findings were consistent with the standard of the lumbar interbody fusion at the last follow-up. In the current study, the minimally invasive treatment concept and the technology of "mobile skin and soft tissue window" are applied to the traditional posterior lumbar interbody fusion surgery. This modified method can not only obtain good vision without special instruments, but can also significantly reduce the skin incision and muscle tissue dissection, get less surgical trauma and better functional recovery, achieving a satisfactory clinical effect for single segment lumbar degenerative disease.

Clinical Follow-Up after Treatment of Degenerative Lumbar Disease by Posterior Dynamic Stabilizing Technique

Introduction: Technique of dynamic fixation for treatment of lumbar degenerative has been developed in avoidance of possible adjacent level degeneration. The dynamic rod, consists of titanium alloy cable cord and polyetheretherketone shell, of K-rod posterior dynamic rod system provides flexible feature that mobility preservation of instrumented level shall be achieved. Clinical research for the usage of K-rid system has not been reported with evidence-based support. This retrospective study was aimed to report clinical outcome of K-rod posterior dynamic rod system utilized for degenerative lumbar disease. Methods: Fifty patients with lumbar degenerative disease ranged from L3 to S1 have been enrolled. Dynamic and hybrid (dynamic rod accompanied by rigid rod) fixations of K-rod system were adequately selected for patients after discectomies of diseased intervertebral discs. Clinical evaluations including Japanese Orthopedidc Association Scores (JOA), Oswestry Disability Index (ODI), and Visualized Analogue Scale (VAS) have been conducted pre- and post-operatively. Results: In the follow-up period (12-36 months, mean 26.4 months), great improvements in JOA, ODI, and VAS were respectively 73.34%, 37.18%, and 77.35% in dynamic fixation group, while those in hybrid fixation group were respectively 76.37%, 30.5%, and 71.68%, with no statistical difference between the two groups. Significantly reduced mobility has been observed in hybrid fixation group compared with its preoperative status. Conclusions: Current follow-up report of K-rod posterior dynamic rod system represented acceptable clinical satisfactory. The preserved mobility of instrumented segment based on sufficient biomechanical stability can successfully achieve pain relief and functional restoration.

Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods.

Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK) have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov'Spine, France) composed of rods made from PEEK-OPTIMA® polymer (Invibio Biomaterial Solutions, UK) without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%), quality of life was improved (ODI = 16%), and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones.

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. Although many outcomes studies have shown good results, currently lacking is a comprehensive report on complications associated with this system, especially in terms of how it compares with reported complication rates of fusion. For the present study, the authors reviewed the literature to find all studies involving the Dynesys dynamic stabilization system that reported complications or adverse events. Twenty-one studies were included for a total of 1166 patients with a mean age of 55.5 years (range 39-71 years) and a mean follow-up period of 33.7 months (range 12.0-81.6 months). Analysis of these studies demonstrated a surgical-site infection rate of 4.3%, pedicle screw loosening rate of 11.7%, pedicle screw fracture rate of 1.6%, and adjacent-segment disease (ASD) rate of 7.0%. Of studies reporting revision surgeries, 11.3% of patients underwent a reoperation. Of patients who developed ASD, 40.6% underwent a reoperation for treatment. The Dynesys dynamic stabilization system appears to have a fairly similar complication-rate profile compared with published literature on lumbar fusion, and is associated with a slightly lower incidence of ASD.

Recent Advances in Finite Element Applications in Artificial Lumbar Disc Replacement

As a new choice for the treatment of degenerative lumbar disease, artificial lumbar disc replacement has been widely used in clinical surgery. The finite element is a very effective method to predict and simulate the surgery effect. The purpose of this paper is to review the applications of finite element in artificial lumbar disc replacement, such as design of artificial lumbar disc prosthesis, risk and effect evaluation of artificial lumbar disc replacement, and assessment of operation methods. Lastly, we discuss the future development of finite element method applied in this field, including personalized design of the prosthesis, postoperative behavior guide, and artificial lumbar disc replacement combined with fusion surgery. In conclusion, as an invaluable complement to biomechanical experiments and clinical studies, the finite element method makes important contributions to our understanding of biomechanics of intervertebral disc, and plays an important role in the field of artificial lumbar disc replacement.

Comparison of bone cement augmented with traditional pedicle screw in the treatment of degenerative lumbar disease

Objective To compare post-operative clinical outcomes between bone cement augmented pedicle screw and traditional pedicle screw in treatment of degenerative lumbar disease. Methods Data of 40 cases with lumbar degenerative disease who had surgery from May 2013 to May 2015 were retrospectively analyzed. They were divided into two groups according to whether the bone cement was injected in the vertebral body with pedicle screw: conventional group and augmented group. There were 5 males and 15 females in conventional group with an average age of 73.2, among them there were 12 cases of lumbar disc prolapse and 8 cases of lumbar spinal stenosis. There were 6 males and 14 females with an average age of 73.7, among them there were 12 cases of lumbar disc prolapse and 8 cases of lumbar spinal stenosis. The screws were inserted into L3, L4, L5, and S1 with a total of 170 vertebral bodies. The Oswestry Disability Iindex (ODI), intervertebral distance of the upper adjacent segments, deformation index of the upper adjacent vertebral body, Cobb angle, concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate were measured pre-operation, 30 d postoperatively and at final follow-up. Results 40 patients were followed-up for 3-24 months (average 12.2 months). The ODI of traditional group and bone cement augmented group respectively was 13.0%±4.9% and 11.0%±8.0%, and there was no significant difference between two groups. The change of Cobb angle of fixed lumbar vertebrae at the final follow-up and 30 days postoperatively was 5.53°±1.64° and 2.15°±0.97°. The concave angle of upper end-plate was increased in bone cement augmented group at 30 days after operation compared with that in conventional group; the lower end-plate concave angle of adjacent centrum, the rectangular index and the adjacent intervertebral space of conventional pedicle screw with bone cement group was all decreased in the final follow-up, and the change of the first two indicators was significantly bigger than those in the conventional pedicle screw group. Conclusion Both groups can effectively treat the degenerative lumbar disease, but bone cement augmented pedicle screw can maintain the stability of the spine of aged patients better. Key words: Osteoporosis; Bone screws; Lumbar vertebrae; Intervertebral disc degeneration

Comparison of clinical and radiographic results between isobar posterior dynamic stabilization and posterior lumbar inter-body fusion for lumbar degenerative disease: A four-year retrospective study

PurposeA retrospective study was conducted to compare clinical outcome with radiographic data and clinical complications between isobar posterior dynamic stabilization (IPDS, Scient’x, France) and posterior lumbar inter-body fusion (PLIF) for lumbar degenerative disease. Methods113 consecutive patients (IPDS group, N=62; PLIF group, N=51) with lumbar degenerative disease were operated on between March 2009 and November 2011. Patient charts, radiographic films and medical records were reviewed. Clinical outcomes including the visual analog scale (VAS), Oswestry disability index (ODI) scores, and radiographic outcomes, including disk height index (DHI) and range of motion (ROM) were retrospectively analyzed. ResultsThe ODI and VAS leg and back pain scores in two groups were significantly improved at 6 and, 24 months and at the final follow-up (all, P<0.05). The degree of improvements in the ODI and VAS back pain scores, the incidence of complications and the rate of adjacent segment degeneration were similar in both groups (P>0.05). However, operation times and blood loss were significantly reduced in the IPDS group (P<0.05). ConclusionIn summary, with similar symptoms improvement and complication rates, the results of this study demonstrate that IPDS is an effective and safe treatment for lumbar degenerative disease. There is currently insufficient evidence to indicate that the IPDS can avoid adjacent segment degeneration therefore, it is essential to conduct prospective, randomized, controlled multicenter studies with larger sample size and longer follow-up.

Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine.

Study Design Retrospective case series. Objective StaXx XD (Spine Wave, Inc., Shelton, CT, United States) is an expandable polyaryl-ether-ether-ketone (PEEK) wafer implant utilized in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. Few studies have focused on expandable PEEK devices. The aim of the current study is to determine the radiographic and clinical outcome of expandable PEEK cages utilized for transforaminal lumbar interbody fusion in patients with lumbar degenerative diseases. Methods Forty-nine patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages and posterior instrumentation were included. The clinical outcome was evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Radiographic parameters including disk height, foraminal height, listhesis, local disk angle of the index level/levels, regional lumbar lordosis, and graft subsidence were measured preoperatively, postoperatively, and at latest follow-up. Results At an average follow-up of 19.3 months, the minimum clinically important difference for the ODI and VAS back, buttock, and leg were achieved in 64, 52, 58, and 52% of the patients, respectively. There was statistically significant improvement in VAS back (6.42 versus 3.11, p < 0.001), VAS buttock (4.66 versus 1.97, p = 0.002), VAS leg (4.55 versus 1.96, p < 0.001), and ODI (21.7 versus 12.1, p < 0.001) scores. There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005). The subsidence of 0.66 mm (7.4%) observed at the latest follow-up was not significant (p = 0.35). Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.

Minimally invasive treatment of lumbar degenerative diseases by anterior lumbar interbody fusion

Objective To explore the clinical efficacy of minimally invasive treatment of lumbar degenerative diseases by anterior lumbar interbody fusion(ALIF). Methods From April 2010 to August 2012, 76 patients with single- level lumbar degenerative diseases were divided into two groups randomly, given ALIF and tranditional posterior lumbar interverbody fusion(PLIF) respectively.The skin incision length,operative time, blood loss and complication were observed.Posterior radiological evaluation was done by MRI image with Taillard index and T2 relaxation time of the operative level on the post- operative month 3.The visual analogue scores(VAS), Oswestry disablility index(ODI) scores and Mac Nab grade were used for clinical assessment. Results All patients were operated successfully and got alleviation of the symptoms to varying degrees.The average skin incision length, the average operative time, the average blood loss and hospital stays were significantly reduced in ALIF group as compared with PLIF group.All cases were followed up for 18- 50 months(average 26.4 months).The complication occurred in 5 cases.At the final followed- up, the radiography showed that 71 cases got bone fusion, and 5 cases got suspicious fusion with the fusion rate being 93.4%.There was significant difference in the average VAS scores and ODI scores between ALIF group and PLIF group in the one- month follow- up.However,at the final follow- up there was no significant difference. Conclusion Minimally invasive treatment of lumbar degenerative diseases by ALIF has the advantages of less invasion, less blood loss, quicker recovery, and less complications.The clinical effect was satisfactory. Key words: Lumbar degenerative diseases; Anterior lumbar interbody fusion; Minimally invasive

Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis.

While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the relative benefits and risks of MI-TLIF versus O-TLIF. Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing MI-TLIF and O-TLIF were included. Data were extracted and analysed according to predefined clinical end points. There was no significant difference in operation time noted between MI-TLIF and O-TLIF cohorts. The median intraoperative blood loss for MI-TLIF was significantly lower than O-TLIF (median: 177 vs 461 mL; (weighted mean difference) WMD, -256.23; 95% CI -351.35, -161.1; P < 0.00001). Infection rates were significantly lower in the minimally invasive cohort (1.2 vs 4.6%; relative risk (RR), 0.27; 95%, 0.14, 0.53; I2) = 0%; P = 0.0001). VAS back pain scores were significantly lower in the MI-TLIF group compared to O-TLIF (WMD, -0.41; 95% CI -0.76, -0.06; I2 = 96%; P < 0.00001). Postoperative ODI scores were also significantly lower in the minimally invasive cohort (WMD, -2.21; 95% CI -4.26, -0.15; I2 = 93%; P = 0.04). In summary, the present systematic review and meta-analysis demonstrated that MI-TLIF appears to be a safe and efficacious approach compared to O-TLIF. MI-TLIF is associated with lower blood loss and infection rates in patients, albeit at the risk of higher radiation exposure for the surgical team. The long-term relative merits require further validation in prospective, randomized studies.

Effect of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease

Objective To investigate the clinical application value of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease. Methods The clinical data of 40 patients who sufferred from lumbar degenerative disease, were randomly divided into two groups: Quadrant system combined with percutaneous pedicle screw fixation to do discectomy and intervertebral bone graft fusion as invasive group(n= 20), traditional posterior lumbar interbody fusion as conventional group(n= 20). The operation time, length of incision,blood loss, postoperative drainage, JOA score of preoperation and postoperation, and effect(reforming Macnab standard)between two groups were recorded and compared. Results Operations were all well done in two groups. The operation time in invasive group was longer than that in traditional group[(147.3±8.9)min,(136.7±10.2)min,t= 3.5,P 0.05).There were no significant differences of JOA scores in preoperation[(12.0±1.7)points,(11.0±1.5)points,P> 0.05],postoperative half a year[(22.0±2.3)points,(21.0±2.5)points,P> 0.05],and postoperative one year[(23.0±1.9)points,(22.0±2.0)points,P> 0.05]. Conclusion Quadrant system combined with percutaneous pedicle screw fixation is a safe,effective and minimally invasive surgical technique in treating lumbar degenerative disease. Compared with conventional group, invasive group has advantages such as less injury, less blood loss, simple operation, and good curative effect, which should be popularized. Key words: Diskectomy,Percutaneous; Internal Fixation

Minimally invasive procedures on the lumbar spine.

Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.