Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease

We retrospectively assessed the indications, safety and efficacy of a new dynamic stabilization system (the Isobar TTL Semi-Rigid Rod System, Scient’x, Bretonneux, France) for the treatment of lumbar degenerative disease in 37 consecutive patients (M:F = 16:21, mean age 40.2 years) with lumbar degenerative disease who underwent surgery between June 2006 and May 2009. One patient was lost to follow-up. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS); range-of-motion (ROM) and disc height index (DHI) were assessed with radiography. Patients were followed for a mean of 24 months (range: 12–36 months). At the 3-month follow-up, there was significant improvement in VAS and ODI (p < 0.05); at long-term follow-up VAS showed additional significant improvement (p < 0.05) and ODI remained stable. At short-term follow-up, DHI was significantly restored (p < 0.05) and ROM declined slightly (but not significantly); however, at long-term follow-up DHI was significantly reduced (p < 0.05) compared to short-term follow-up and ROM was significantly decreased compared to the preoperative values (p < 0.05). There were new signs of degeneration at adjacent levels in 14 patients (39%) on long-term follow-up MRI. Revision was required in three patients (8%) 24 months after the first operation due to adjacent segment disease. Screw loosening was observed in four patients (11%). The Isobar System after microsurgical decompression for lumbar degenerative disease provided excellent improvement in leg and back pain and patient satisfaction at late follow-up; however, evidence to suggest that Isobar outperforms traditional fusion is lacking. Larger studies of longer duration are warranted.     

Endoscopy-assisted posterior lumbar interbody fusion in a single segment

Posterior lumbar interbody fusion (PLIF) has been routinely performed for the treatment of lumbar segmental lesions. However, traditional PLIF procedures can result in a variety of approach-related morbidities. The purpose of this study was to determine the efficacy of endoscopy-assisted PLIF in lumbar arthrodesis. From July 2005 to May 2007, a total of 56 patients underwent PLIF, including 24 endoscopy-assisted operations (endoscopic group) and 32 traditional open operations (open group). The perioperative data, clinical outcomes and radiographic results were compared. The intraoperative bleeding volume, postoperative drainage volume, intraoperative and postoperative allogeneic blood transfusion volumes, values for C-reactive protein and erythrocyte sedimentation rate on postoperative day 3 and postoperative hospitalization days were decreased in the endoscopic group (p < 0.05), while the operative time was longer than that of the open group (p = 0.026). According to the Visual Analog Scale for pain, the postoperative low back pain score in the endoscopic group was lower than that observed in the open group (p < 0.05). In the endoscopic group, the excellent and good outcome rate was 87.5%, the incidence of complications was 8.3%, and the intervertebral fusion rate was 100%. There were no significant differences for these outcomes when compared with the open group (p > 0.05). Endoscopy-assisted PLIF can achieve a clinical efficacy similar to that of traditional open operations while minimizing destruction to adjacent tissues. This technique is safe and is characterized by less bleeding, less tissue trauma, decreased postoperative pain, rapid recovery, and a shorter postoperative hospital stay.     

Coflex棘突间动力重建系统治疗腰椎退变性疾病18例

背景：近年来脊柱非融合技术一直是脊柱外科研究与争论的热点。Coflex棘突间动力重建系统作为腰椎后路非融合器材,国外虽已应用较长时间,但国内尚处于试用阶段。 目的：探讨Coflex棘突间动力重建系统治疗腰椎退变性疾病的适应证,并对其早期临床疗效进行评价。 方法：2008-10/2010-06使用Coflex棘突间动力重建系统治疗腰椎退变性疾病31例,对其中随访超过1年的18例患者临床资料进行分析总结。治疗方式均为后路髓核摘除,椎管减压、Coflex棘突间动力重建系统置入;1例患者术中置入2枚Coflex。治疗前及各次随访时均对患者进行日本骨科学会下腰痛功能量表、中文版Oswestry功能障碍指数量表及目测类比评分法评估,并测量治疗前后、各次随访时腰椎前屈后伸位置入节段及其上下节段活动范围、Colfex上下极板夹角及置入节段椎间隙高度。 结果与结论：患者均获随访,随访时间12~20个月。末次随访时患者日本骨科学会下腰痛功能量表评分、中文版Oswestry功能障碍指数量表评分及目测类比评分均获显著改善;治疗前后置入节段椎间高度及其上下节段椎间活动度差异均无显著性意义(P > 0.05),末次随访时Coflex上下极板夹角在过伸位较中立位显著增大(P < 0.05)。提示Coflex棘突间动力重建系统对腰椎间盘突出症、椎管狭窄及腰椎不稳等腰椎退变性疾病安全有效,在腰椎后伸时能够有效分担载荷,同时对腰椎生理活动影响较小,有利于维护腰椎功能,早期临床疗效肯定。     

Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8 months. The average operative time was 103 ± 18.5 min, and the average blood loss was 115 ± 13.3 mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively (P < 0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2 months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.     

Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis

This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20–60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2–5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8 ± 63.5 minutes and 253.2 ± 57.6 minutes, respectively; p = 0.002) and intraoperative blood loss (1166.7 ± 554.1 mL and 1673.7 ± 922.4 mL, respectively; p = 0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p = 0.033 and p = 0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option.     

A meta-analysis comparing ALIF,PLIF, TLIF and LLIF

IntroductionLumbar interbody fusions have been widely used to treat degenerative lumbar disease that fails to respond to conservative treatment. This procedure is divided according to its approach: anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF). Each approach has its own theoretical advantages and disadvantages; however, there have been no studies that compared these.MethodsVarious full-text databases were systematically searched through December 2015. Data regarding the radiological, operative and clinical outcomes of each lumbar interbody fusion were extracted. All outcomes were pooled using random effects meta-analysis, with the relative risk (RR) and/or weighted mean difference (WMD) as the summary statistic.ResultsThirty studies met the inclusion criteria. The ALIF procedure has been studied most intensively, followed by PLIF, TLIF and LLIF respectively. All four approaches had similar fusion rates (p = 0.320 & 0.703). ALIF has superior radiological outcome, achieving better postoperative disc height (p = 0.002 & 0.005) and postoperative segmental lordosis (p = 0.013 & 0.000). TLIF had better Oswestry Disability Index scores (p = 0.025 & 0.000) while PLIF had the greatest blood loss (p = 0.032 & 0.006). Complication rates were similar between approaches. Other comparisons were either inconclusive or lacked data. There was marked less studies comparing against LLIF.ConclusionsEach approach has their own risks and benefits but similar fusion rates. Despite the large number of studies, there is little data overall when comparing specific aspects of lumbar interbody fusions. More studies, especially RCTs are needed to further explore this topic.     

Indirect decompression and reduction of lumbar spondylolisthesis does not result in higher rates of immediate and long term complications

Nerve root decompression and spondylolisthesis reduction is typically reserved for open surgery. MIS techniques have been thought to be associated with higher rates of neurological complications. This study aims to report acute and chronic neurologic complications encountered with MIS surgery for spondylolisthesis, specifically, the incidence of nerve root injury and clinical and radiographic outcomes. A retrospective review of 269 patients who underwent MIS LIF or ALIF treatment for lumbar degenerative or isthmic grade 1 or 2 spondylolisthesis was conducted. Immediate and long-term complication rates were the primary outcome. Only patients who had symptomatic anterolisthesis and 2-year outcome data were included in the study. 52 patients met inclusion criteria with 54 lumbar spondylolisthesis levels treated. Five patients (9.6%) experienced postoperative anterior thigh numbness, which completely resolved within 3 months. There were no permanent neurologic deficits; however, 2 patients (3.8%) suffered a transient foot weakness that resolved with physical therapy by 3 months follow-up. There was one incidence of wound breakdown that required revision and one incidence of L5/S1 endplate/sacral promontory fracture and relisthesis 3 months postoperatively. Overall fusion rate was 98% at 6 months. Indirect decompression and closed anatomical reduction for treatment of low-grade spondylolisthesis using ALIF and LIF with posterior percutaneous fixation was not associated with an increased risk of neurologic deficit. This study suggests that this technique is safe, reproducible, durable, and provides adequate fusion rates.     

Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6 months after surgery, and once every 6 months thereafter. The mean follow-up was 26.6 months (range 18–36 months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12 months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease.     

Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease

There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2 months and 6 months (p < 0.0001). The mean pelvic index was 48.6° ± 11.9° (± standard deviation, SD) with corresponding mean sacral slopes and pelvic tilt of 32.0° ± 10.6° (SD) and 18.0° ± 9.5 (SD), respectively. XLIF did not significantly affect sacral slope or pelvic tilt (p > 0.2). Global lumbar lordosis was not affected by XLIF (p > 0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (p < 0.0001) and significantly decreased the scoliotic Cobb angle by 5.9° (p = 0.01). We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance.     

置入棘突间稳定系统Wallis治疗腰椎退变性疾病：与单纯腰椎管减压的比较☆

背景：在早期,腰椎间盘退变性疾病的治疗临床常用髓核摘除或髓核摘除加刚性内固定融合技术,但是随着非刚性固定技术的发展,棘突间稳定系统固定和全椎间盘置换在脊柱非融合治疗中逐渐受到人们的重视,其优点日益突出。 目的：与单纯腰椎管减压相比,评价腰椎管减压并棘突间稳定系统Wallis置入固定治疗腰椎退变性疾病的效果。 方法：选择2007-12/2008-12华中科技大学附属同济医院骨科收治的腰椎退变性疾病患者40例,随机选取20例行单纯髓核摘除(对照组),20例行突出髓核摘除加棘突间稳定系统Wallis固定(实验组)。分别于置入后1周,1年对两组患者分别进行JOA评分、目测类比评分。 结果与结论：两组患者置入后1周JOA评分及目测类比评分差异均无显著性意义(P > 0.05);术后1年JOA评分及目测类比评分差异均有显著性意义(P < 0.05)。提示两术式即刻效果无差异,均取得良好的效果,此效果主要依赖于手术有效的减压。实验组中期效果明显优于乙组,主要是棘突间稳定系统Wallis发挥良好的生物学作用,有效缓解了患者残余的慢性下腰痛。 关键词：腰椎退变性疾病;椎管减压;棘突间稳定系统;硬组织植入物     

Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct

In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation time, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and survivorship without the need for revision surgery. Telephone follow-ups were conducted to ascertain survivorship, clinical outcomes (VAS, ODI) and patient satisfaction. Operation time was longer in the hybrid group (p = 0.021). The hybrid group showed a significant improvement in VAS and ODI with 52.2% and 50.0% improvement versus 28.3% and 25.5% in the ALIF group (p < 0.05). At the telephone follow-up for patient satisfaction, 95.7% (n = 22) of the hybrid group were satisfied and 95.2% (n = 21) of the ALIF group were satisfied. Seventy-four percent (n = 17) in the hybrid group and 85.7% (n = 18) in the ALIF group would choose to do the initial surgery again. Kaplan–Meier analysis showed 80.5% survivorship for hybrids and 75.9% for ALIF at 5 years. With our clinical outcomes in VAS and ODI scores, these results, when taken together, indicate that hybrid fusion is a valid and viable alternative to ALIF fusion, with at least equal if not better clinical outcomes in terms of survivorship, back pain, and disability scores.     

A systematic review and meta-analysis of outcomes in hybrid constructs for multi-level lumbar degenerative disc disease

A systematic review and meta-analysis was performed to assess the effect of hybrid constructs which involve a total disc arthroplasty (TDA) with stand-alone anterior lumbar interbody fusion (ALIF) versus non-hybrid constructs including multi-level TDA, multi-level transforaminal lumbar interbody fusion (TLIF) with posterior transpedicular fixation or multi-level stand-alone ALIF as a surgical intervention for degenerative disc disease (DDD) in the lumbar spine. Primary outcomes analysed included the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back pain. A systematic search of Medline, Embase, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar was undertaken by two separate reviewers and a meta-analysis of the outcomes was performed. Three studies met our search criteria. When comparing hybrid constructs to multi-level TDA or lumbar fusion (LF) improvements in back pain were found with a VAS back pain score reduction of 1.38 (P < 0.00001) postoperatively and a VAS back pain score reduction of 0.99 points (P = 0.0006) at 2-years follow-up. Results so far slightly favour clinically significant improved VAS back pain score outcomes postoperatively and at 2-years follow-up for hybrid constructs in multi-level lumbar DDD of the spine when compared with non-hybrid multi-level LF or TDA. It cannot however be concluded that a hybrid construct is superior to multi-level LF or TDA based on this meta-analysis. The results highlight the need for further prospective studies to delineate best practice in the management of degenerative disc disease of the lumbar spine.     

Evaluation of outcomes of discectomy with a dynamic neutralization system in treatment of lumbar disk herniation

ObjectiveThe study aimed to explore the clinical outcomes of discectomy with dynamic neutralization system (Dynesys) for single-segmental lumbar disk herniation (LDH) versus simple discectomy.MethodsThe eligible patients with single-segmental LDH were randomly divided into the discectomy with Dynesys group (group A) and the simple discectomy group (group B). The Oswestry disability index (ODI), visual analog score (VAS), radiological results of intervertebral height and range of motion (ROM) of the treated segment were evaluated pre- and post-operatively in both groups. Operation duration and blood loss were recorded. Complications, reoperation, and mortality were also assessed. All patients received a 2-year follow-up.Results123 (96.1%) participants completed the follow-up. The operation duration and blood loss of group B were significantly lower than those of group A (p < 0.05). After operation, ODI and VAS were improved significantly in both groups, and there was no significant difference between the two groups immediately after surgery. But a rising trend was found in ODI and VAS of group B, especially after the 1-year follow-up (p < 0.05). X-rays showed a continuing loss of intervertebral height of the treated segment in group B, while it was preserved in group A (p < 0.05). ROM of the treated segment was also maintained stable in group A.ConclusionDiscectomy with Dynesys is safe and effective for LDH treatment.     

腰椎棘突间置入动态内固定Coflex系统治疗中年腰椎旋转不稳：近期腰椎稳定性评价

背景：腰椎棘突间动态内固定Coflex系统主要用于治疗轻度腰椎管狭窄病例,其适应范围是否可有进一步的扩大？ 目的：观察腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效。 方法：对腰椎旋转不稳的11例中年患者行Coflex内固定术,均为L4~5节段性不稳定。所有患者术前及术后均行日本骨科学会(JOA)评分;观测影像指标包括手术前术后椎间隙中立角,过伸角,过屈角和 L4~5活动度。观察手术时间,术中出血量。 结果与结论：全部患者随访6个月。Coflex置入时间平均72.6 min,平均出血85.7 mL。术后6个月随访时,JOA评分由术前14.45±2.42提高到21.00±2.24,差异有显著性意义(P < 0.05)。L4~5活动度由术前(13.18±2.04)°减少到(8.09±0.94)°,差异有显著性意义(P < 0.05)。提示腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效良好,腰椎稳定性有明显提高,中远期疗效尚待观察。     

Effect of steerable cage placement during minimally invasive transforaminal lumbar interbody fusion on lumbar lordosis

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used for the treatment of a variety of degenerative spine disorders. Recently, steerable interbody cages have been developed which potentially allow for greater restoration of lumbar lordosis. Here we describe a technique and radiographic results following minimally invasive placement of steerable cages through a bilateral approach. A retrospective review was conducted of the charts and radiographs of 15 consecutive patients who underwent 19 levels of bilateral MIS-TLIF with the placement of steerable cages. These were compared to 10 patients who underwent 16 levels of unilateral MIS-TLIF with the placement of bullet cages. The average age, body mass index, distribution of the levels operated and follow-up were similar in both groups. The average height of the steerable cage placed was 10.9 mm compared to 8.5 mm for bullet cages. The preoperative focal Cobb’s angle per level was similar between both groups with a mean of −5.3 degrees for the steerable cage group and −4.8 degrees for the bullet cage group. There was a significant improvement in postoperative Cobb’s angle after placement of a steerable cage with a mean of −13.7 (p < 0.01) and this persisted at the last follow-up with −13 degrees (p < 0.01). There was no significant change in Cobb’s angle after bullet cage placement with −5.7 degrees postoperatively and a return to the baseline preoperative Cobb’s angle of −4.8 at the last follow-up. Steerable cage placement for MIS-TLIF improves focal lordosis compared to bullet cage placement.     

Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: A comparative study

This retrospective study aimed to compare the patient-reported outcomes and radiographic assessment of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis with reduction versus in situ fusion. Patients receiving MI-TLIF with reduction were assigned as Group A, and those without reduction were assigned as Group B. Radiographic fusion was assessed using Bridwell’s grading criteria. Preoperative and postoperative patient-reported outcomes including visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) scale and improvement rate were analyzed. There were 41 patients in Group A and 37 patients in Group B. The mean follow-up was 30.78 ± 14.15 months in Group A and 28.95 ± 10.75 months in Group B (p = 0.525). There were no significant differences in hospital stay (p = 0.261), estimated blood loss (p = 0.639), blood transfusion (p = 0.336), operation time (p = 0.762) and complications (p = 1.00) between the two groups. Radiographic fusion rate was 92.68% (38/41) in Group A, and 81.08% (30/37) in Group B (p = 0.110). Significant differences were observed in either 3-month or last follow-up JOA, VAS, and ODI compared with preoperative JOA, VAS, and ODI, respectively (p < 0.05). However, there were no significant differences in JOA, VAS, and ODI between the two groups whenever preoperatively, or 3-month postoperatively, or at the last follow-up (p > 0.05). According to MacNab criteria, the excellent and good rate was 85.37% in Group A and 86.49% in Group B (p = 0.983). MI-TLIF is an effective and satisfactory surgical technique to manage degenerative spondylolisthesis regardless of reduction or not, so routine reduction may not be a requirement in MI-TLIF for degenerative spondylolisthesis.     

Coflex interspinous process dynamic stabilization for lumbar spinal stenosis: Long-term follow-up

ObjectiveTo evaluate the long-term efficacy of Coflex dynamic stabilization device in the treatment of lumbar spinal stenosis.MethodsThe clinical and imaging data of 73 patients undergoing Coflex dynamic stabilization surgery from July 2008 to June 2012 were retrospectively analyzed. All patients had a minimum of 8 years of follow-up. Clinical data were used to assess the clinical efficacy, and radiographic parameters were measured for evaluation of ASD.Results56 Patients were followed up for 107.6 ± 13.3 months. The visual analogue scale of pain (VAS), Owestry disability index (ODI) and Japanese Orthopedic Association Scores (JOA) improved significantly after surgery. At 6 months after surgery and the last follow-up, lumbar range of motion (ROM) was significantly lower than that before surgery (P < 0.001). ROM was slightly increased at the last follow-up compared with that 6 months after operation (P > 0.05). ROM of adjacent segments increased at 6 months and at the last follow-up compared with that before surgery (P > 0.05). At 6 months after surgery, intervertebral space height (ISH) and intervertebral foramen height (IFH) of implanted segment was significantly higher than that before surgery (P < 0.05). At the last follow-up, there was a decrease in ISH and IFH (P > 0.05). During the follow-up period, a total of 11 patients (19.6%) experienced complications and 6 patients (10.7%) underwent secondary surgery.ConclusionCoflex interspinous process dynamic stabilization is effective in the long-term treatment of lumbar spinal stenosis, the ISH and IFH of implanted segment could be increased in a short period of time.     

Combination Ti/PEEK ALIF cage for anterior lumbar interbody fusion: Early clinical and radiological results

Anterior lumbar interbody fusion (ALIF) is a common procedure for patients with degenerative pathologies of the lumbar spine. In this study, the clinical and radiological outcomes of a combination titanium/polyetheretherketone (Ti/PEEK) ALIF cages in one, two and three-level surgery were evaluated. Over an 18-month time period, a prospective single surgeon series of 20 implants (15 patients) were included in the study, with minimum 10-months follow-up. From these 15 patients, two were supplemented with posterior percutaneous pedicle screw fixation for additional stability. Radiological follow-up with fine cut CT scan at 9–12 months was performed to evaluate early fusion rates, and integration of the Titanium/PEEK cage at the endplate junction. 20 implants were followed for a minimum of 10 months, and a mean of 15 months. A 95% (19/20 implants) fusion rate with no implant related complications was achieved at the mean 15-month postoperative mark. Patients experienced statistically significant improvement in pain and functional outcomes (SF12 and ODI) compared to their pre-operative status. A single patient with a non-union at L5/S1 (smoker) did not experience any improvement in symptoms. A Ti–PEEK cage, with allograft and BMP-2 to achieve interbody fusion is an effective implant for use in anterior lumbar surgery with high fusion rates, no lucency around the titanium endplates at follow-up, and with promising early results.     

Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5–S1 level

The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5–S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5–S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n = 22), moderate (n = 14) or severe (n = 11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1 year follow-up from 7.3 at baseline to 2.75 (p < 0.001) in Group 1 and from 6.7 to 1.5 (p = 0.001) in Group 2. VAS score at 1 year showed significant improvements in 21 Group 1 patients versus 30 Group 2 patients (p = 0.001). Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.