Comparison of Outcomes of Oblique Lateral Interbody Fusion with Percutaneous Posterior Fixation in Lateral Position and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

Koike Yoshinao,Kotani Yoshihisa,Terao Hidemasa,Iwasaki Norimasa 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: Single-center retrospective study.Purpose: To compare the physical function and quality of life (QOL) parameters of two minimally invasive surgical (MIS) procedures: oblique lateral interbody fusion with percutaneous posterior fixation in lateral position (OLIF-LPF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level degenerative spondylolisthesis (DS). Overview of Literature: To date, many options for the surgical treatment of lumbar DS and reports have described the effectiveness of minimally invasive lateral access surgery and MIS-TLIF. However, there is still a paucity of comparative data regarding the physical function and QOL outcomes of OLIF and MIS-TLIF.Methods: Eighty-six patients were enrolled in this study (group O: OLIF-LPF, n=38; group T: MIS-TLIF, n=48). We evaluated the operation time, estimated blood loss (EBL), postoperative laboratory data, preoperative and postoperative radiographic parameters, overall functional outcome with the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate, and Visual Analog Scale (VAS) score for low back pain, leg pain, and leg numbness.Results: No statistical differences in operation time, EBL, and C-reactive protein level, 5 days postoperatively, between groups O and T. With respect to radiological outcome, preoperative and postoperative disc height change was significantly greater in group O than in group T (3.8 vs. 1.8 mm, p<0.05). Both groups showed postoperative improvements in the clinical outcome scores of all JOABPEQ domains, but the effectiveness rate increase in the psychological domain was significantly higher in group O than in group T (47.1% vs. 14.6%, p<0.05). No differences in the preoperative and postoperative VAS score change were noted between the two groups in any of the items.Conclusions: The changes in physical function and QOL parameters after OLIF-LPF and MIS-TLIF were almost equivalent; however, OLIF-LPF had significant superiority in the psychological domain.

Risk Factor Analysis of Proximal Junctional Kyphosis after Surgical Treatment of Adult Spinal Deformity with Oblique Lateral Interbody Fusion

Koike Yoshinao,Kotani Yoshihisa,Terao Hidemasa,Iwasaki Norimasa 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: A single-center retrospective study.Purpose: To investigate the prevalence of proximal junctional kyphosis (PJK) and its risk factors after surgical treatment of adult spinal deformity (ASD) with oblique lateral interbody fusion (OLIF).Overview of Literature: Correction of ASD using OLIF has been developed because it is less invasive, and enables correction of severe deformities. Although PJK is a well-recognized complication after the correction of spinal deformity, few studies have evaluated the prevalence and risk factors for PJK after OLIF for ASD.Methods: We reviewed 74 patients who underwent surgery for ASD. PJK was defined as a proximal junction sagittal Cobb angle exceeding 10°, and at least 10° greater than the preoperative measurement. We investigated the following as risk factors: age, sex, body mass index, medical history, number of fused segments, number of interbody fusions, number of OLIFs, number of osteotomies, level of upper instrumented vertebrae, lowest instrumented vertebrae, and radiographic parameters.Results: The mean follow-up duration was 22.4 months and the mean age of the patients was 73.6 years. PJK was present in 19/74 patients (25.7%) and absent in 55/74 (74.3%). In the univariate analysis, those with PJK had a significantly higher proportion of patients with a history of vertebral compression fracture (7/19 patients [36.8%] vs. 6/55 patients [10.9%], p=0.027). Those with PJK had a significantly higher proportion of patients with fusion to the pelvis (18/19 patients [94.7%] vs. 34/55 patients [61.8%], p=0.016). According to the multivariate analysis, fusion to the pelvis was a significant risk factor for PJK.Conclusions: Fusion to the pelvis was the most important risk factor for PJK. A history of vertebral compression fracture served as an additional risk factor for PJK. Clinicians should consider these factors before treating ASD patients with OLIF.

Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Sur

Mohamed Elmekaty,Yoshihisa Kotani,Emad El Mehy,Yohan Robinson,Ahmed El Tantawy,Ivan Sekiguchi,Ryo Fujita 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.5

Study Design: Retrospective cohort study. Purpose: Comparison between three different minimally invasive surgical (MIS) fusion techniques for single-level lumbar spondylolisthesis. Overview of Literature: There has been an increase in the development and utilization of MIS techniques for lumbar spine fusion. No study has compared the efficacy of MIS-posterolateral fusion (MIS-PLF), MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) with modified cortical bone trajectory screws for lumbar spondylolisthesis. Methods: Fifty-nine patients with single-level lumbar spondylolisthesis and a minimum follow-up period of 1 year were included in this study. The MIS-PLF, MIS-TLIF, and MIDLF groups included 22, 15, and 22 patients, respectively. The average age of the groups was 70.6, 49.3, and 62.7 years, respectively. The evaluation parameters were operation time, intraoperative bleeding, serum C-reactive protein (CRP) value, creatine kinase (CK) value, and overall functional outcome as per the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score. The changes in the lumbar lordosis angle (LLA), segmental disc angle (SDA), and disc height were measured. Fusion rate, screw loosening, and loss of correction were also assessed. Results: MIDLF showed a significantly shorter operation time (111 min), less bleeding amount (112.5 mL), and lower values of CRP and CK than the other two techniques. There was no significant difference in the JOABPEQ scores of the three groups. MIDLF resulted in a greater increase in the LLA and SDA postoperatively. MIDLF and MIS-TLIF resulted in a significant increase in the middle disc height compared with MIS-PLF. MIDLF showed a lower loss of correction after 6 months postoperatively (2.6%) than MIS-PLF (5.2%) and MIS-TLIF (4.2%). The fusion rate was 100% in the MIDLF and MIS-TLIF groups and 90% in the MIS-PLF group. Screw loosening occurred in 10% of the MIS-PLF cases, 7.14% of the MIS-TLIF cases, and 4.76% of the MIDLF cases. Conclusions: MIDLF was the least invasive, and there was no significant difference between the three groups in terms of fusion, screw loosening, and clinical outcomes.

Effect of Indirect Neural Decompression with Oblique Lateral Interbody Fusion Was Influenced by Preoperative Lumbar Lordosis in Adult Spinal Deformity Surgery

Tan Boon Beng,Yoshihisa Kotani,Ung Sia,Ivan Gonchar 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.5

Study Design: Retrospective clinical study on the indirect decompressive effect of oblique lateral interbody fusion (OLIF) for adult spinal deformity. Purpose: To evaluate the effect of interbody distraction by OLIF for the treatment of adult spinal deformity. Overview of Literature: Adult spinal deformity with symptomatic stenosis has been addressed conventionally using a direct posterior decompression approach with fusion. However, stenotic symptoms can also be alleviated indirectly through restoration of intervertebral and foraminal heights and correction of spinal alignment. Methods: Twenty-eight patients with adult spinal deformity underwent OLIF combined with modified cortical bone trajectory screws at 94 lumbar levels with neuromonitoring. The patients were divided into three groups based on their preoperative lumbar lordosis: group A, <0°; group B, 0°–20°; and group C, >20°. The cross-sectional area (CSA) of the thecal sac was measured preoperatively and postoperatively on axial magnetic resonance images. Differences in CSA were evaluated, and the relationship between the CSA extension ratio and preoperative CSA was assessed. Changes in disc height and segmental disc angle were measured from plain radiographs. Results: OLIFs were performed successfully without neural complications. In group A, the mean CSA increased from 120.6 mm2 preoperatively to 148.5 mm2 postoperatively (p<0.001). The mean CSA for group B increased from 120.1 mm2 preoperatively to 154.4 mm2 postoperatively (p<0.001). Group C had an increase in mean CSA from 114.7 mm2 preoperatively to 160.7 mm2 postoperatively (p<0.001). The mean CSA enlargement ratio was 27.5%, 32.1%, and 60.4% in groups A, B, and C, respectively. The mean CSA extension ratio was inversely correlated with preoperative CSA. Conclusions: The effect of indirect neural decompression in adult spinal deformity with OLIF varies with the degree of preoperative lumbar lordosis.

Correlation between the Computed Tomography Values of the Screw Path and Pedicle Screw Pullout Strength: An Experimental Study in Porcine Vertebrae

Ikeura Atsushi,Kushida Taketoshi,Oe Kenichi,Kotani Yoshihisa,Ando Muneharu,Adachi Takashi,Saito Takanori 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: Biomechanical study.Purpose: To assess the correlation between the computed tomography (CT) values of the pedicle screw path and screw pull-out strength.Overview of Literature: The correlation between pedicle screw pull-out strength and bone mineral density has been well established. In addition, several reports have demonstrated a correlation between bone mineral density and CT values. However, no previous biomechanical studies investigated the correlation between CT values and pedicle screw pull-out strength.Methods: Sixty fresh-frozen lumbar vertebrae from 6-month-old pigs were used. Before screw insertion, the CT values of the screw path were obtained for each sample. Specimens were then randomly divided into three equal groups. Each group had one of three pedicle screws inserted: 4.0-mm LEGACY (4.0-LEG), 4.5-mm LEGACY (4.5-LEG), or 4.5-mm SOLERA (4.5-SOL) (all from Medtronic Sofamor Danek Inc., Memphis, TN, USA). Each screw had a consistent 30-mm thread length. Axial pull-out testing was performed at a rate of 1.0 mm/min. Correlations between the CT values and pedicle screw pull-out strength were evaluated using Pearson’s correlation coefficient analysis.Results: The correlation coefficients between the CT values of the screw path and pedicle screw pull-out strength for the 4.0-LEG, 4.5-LEG, and 4.5-SOL groups were 0.836 (<i>p</i> <0.001), 0.780 (<i>p</i> <0.001), and 0.873 (<i>p</i> <0.001), respectively. Greater CT values were associated with greater screw pull-out strength.Conclusions: The CT values of the screw path were strongly positively correlated with pedicle screw pull-out strength, regardless of the screw type and diameter, suggesting that the CT values could be clinically useful for predicting pedicle screw pull-out strength.