Comparison of Different Approaches in Lumbosacral Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

Lenz Maximilian,Mohamud Kaliye,Bredow Jan,Oikonomidis Stavros,Eysel Peer,Scheyerer Max Joseph 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

We aimed to systematically review the literature to analyze the differences in posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion (ALIF), and transforaminal lumbar interbody fusion (TLIF), focusing on the complications, risk factors, and fusion rate of each approach. Spinal fusion surgery is a well-established surgical procedure for a variety of indications, and different approaches developed. The various approaches and their advantages, as well as approach-related pathology and complications, are well investigated in spinal surgery. Focusing only on lumbosacral fusion, the comparative studies of different approaches remain fewer in numbers. We systematically reviewed the literature on the complications associated with lumbosacral interbody fusion. Only the PLIF, ALIF, or TLIF approaches and studies published within the last decade (2007–2017) were included. The exclusion criteria in this study were oblique lumbar interbody fusion, extreme lateral interbody fusion, more than one procedure per patient, and reported patient numbers less than 10. The outcome variables were indications, fusion rates, operation time, perioperative complications, and clinical outcome by means of Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopaedic Association score. Five prospective, 17 retrospective, and two comparative studies that investigated the lumbosacral region were included. Mean fusion rates were 91,4%. ALIF showed a higher operation time, while PLIF resulted in greater blood loss. In all approaches, significant improvements in the clinical outcome were achieved, with ALIF showing slightly better results. Regarding complications, the ALIF technique showed the highest complication rates. Lumbosacral fusion surgery is a treatment to provide good results either through an approach for various indications as causes of lower back pain. For each surgical approach, advantages can be depicted. However, perioperative complications and risk factors are numerous and vary with ALIF, PLIF, and TLIF procedures, as well as with fusion rates.

Implant-Associated Infection of Long-Segment Spinal Instrumentation: A Retrospective Analysis of 46 Consecutive Patients

Oikonomidis Stavros,Altenrath Lisa,Westermann Leonard,Bredow Jan,Eysel Peer,Scheyerer Max Joseph 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

Study Design: This single-center retrospective study analyzed patients with an implant-associated infection of spinal instrumentation (four or more segments) treated between 2010 and 2018.Purpose: This study aimed to investigate the treatment of implant-associated infections of long-segment spinal instrumentation and to define risk factors for implant removal.Overview of Literature: Implant-associated infection occurs in 0.7%–20% of spinal instrumentation. Significant blood loss, delayed reoperation, and use of effective antibiotics are reported risk factors for implant removal.Methods: Patients with superficial infections not involving the implant were excluded. All patients received surgical and antibiotic treatments according to our interdisciplinary osteomyelitis board protocol. An infection was considered healed if a patient showed no signs of infection 1 year after termination of treatment. The patients were divided into an implant retention group and implant removal group, and their clinical and microbiological data were compared.Results: Forty-six patients (27 women, 19 men) with an implant-associated infection of long-segment spinal instrumentation and mean age of 65.3±14.3 years (range, 22–89 years) were included. The mean length of the infected instrumentation was 6.5±2.4 segments (range, 4–13 segments). Implant retention was possible in 21 patients (45.7%); in the other 25 patients (54.3%), a part of or the entire implant required removal. Late infections were associated with implant removal, which correlated with longer hospitalization. Both groups showed high postoperative complication rates (50%) and high mortality rates (8.7%). In 39 patients (84.8%), infection was eradicated at a mean follow-up of 18.9±11.1 months (range, 12–60 months). Three patients (6.5%) were lost to follow-up.Conclusions: Implant-associated infections of long-segment spinal instrumentations are associated with high complication and mortality rates. Late infections are associated with implant removal. Treatment should be interdisciplinary including orthopedic surgeons and clinical infectiologists.

Insertion Angle of Pedicle Screws in the Subaxial Cervical Spine: The Analysis of Computed Tomography-Navigated Insertion of Pedicle Screws

Stavros Oikonomidis,Frank Beyer,Carolin Meyer,Christoph Tobias Baltin,Peer Eysel,Jan Bredow 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.1

Study Design: Four orthopedic spine surgeons measured the radiological parameters of pedicle screws in the cervical spine using a postoperative computed tomography (CT) scan. Purpose: This study analyzed the insertion angle of CT-navigated insertion of pedicle screws in the subaxial cervical spine and classified them according to their position. Overview of Literature: Overall, a pedicle transverse angle of 33.6°–50.2° with a mean angle of 45° relative to the midline has been reported in the literature. Methods: The insertion angles of 87 pedicle screws inserted using CT-based navigation in the subaxial cervical spine were measured in the postoperative CT. The screw positioning was determined according to the modified Gertzbein and Robbins classification. Results: Total 89.3% (n=78) of the pedicle screws inserted using CT-based navigation showed good placement. The mean insertion angle of the pedicle screws that showed good positioning was 29.9°±9.9°. The pedicle screws showing bad positioning had a mean insertion angle of 26.8°±10.5° (p=0.157). The interobserver reliability showed a reliable measurement intraclass correlation coefficient: 0.994 (95% confidence interval, 0.992–0.996). Conclusions: The present results show that the insertion angle of the pedicle screws in the subaxial cervical spine was smaller than the actual pedicle transverse angle, as per the literature. One reason for this discrepancy could be that the navigation systems allow the insertion of cervical pedicle screws with a lower convergence.

Impact of the Vestibular System on the Formation and Progression to Idiopathic Scoliosis: A Review of Literature

Scheyerer Max Joseph,Rohde Axel,Stuermer Konrad Johannes,Kluenter Heinz-Dieter,Bredow Jan,Oikonomidis Stavros,Klußmann Jens Peter,Eysel Peer,Eysel-Gosepath Kathrin 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

The physiopathogenesis of adolescent idiopathic scoliosis remains unknown. However, a multifactorial pathogenesis is being assumed. Besides biomechanical, biochemical, and genetic factors, some studies have focused on congenital or acquired abnormalities in the vestibular organ with consecutive development of scoliosis. This study aims to analyze a possible correlation between any vestibular organ congenital or acquired pathologies and scoliosis based on the current literature. Therefore, we conducted a literature search in three databases, with search terms such as “scoliosis,” “organ of balance,” “idiopathic scoliosis,” “vestibular organ,” “spine,” and “balance.” Fifteen studies were selected and used for research. The relationship between scoliosis and vestibular organ abnormalities was recorded from all included works. Seven studies demonstrated a direct correlation between vestibular organ anatomical abnormalities and the form of the scoliotic spine. Another study confirmed the influence of the pathology of the vestibular organ on scoliosis but questioned whether it had an impact on the formation or the progression of the curvature. Others demonstrated a temporal overlap of the embryonic development of the vestibular organ and the beginning of pre-scoliotic characteristics, but their relationship remained questionable. In three studies, the correlation remained unclear, and any context has been denied. It seems unlikely that an isolated vestibular disorder can trigger structural scoliosis. However, the vestibular system pathologies may certainly occur in the multifactorial genesis of idiopathic scoliosis. Whether the correlation refers to the expression or the progression of scoliosis or may even have an influence on both remains unclear. New treatment options could be derived from these findings with a positive influence on the course of the deformity.

Endoscopic Facet Joint Denervation on the Lumbar Spine: A Retrospective Analysis

Wallscheid Franziska,Manthey Maximilian,Olsen Jerome,Oikonomidis Stavros,Meyer Carolin,Eysel Peer,Löhrer Lars,Bredow Jan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: This single-center retrospective study analyzed patients with chronic low back pain (CLBP) who underwent endoscopic facet joint denervation (EFJD) between April 2018 and May 2019.Purpose: This study was designed to investigate the effectiveness of EFJD in treating CLBP.Overview of Literature: CLBP is a challenging burden to healthcare systems worldwide. As up to 45% of cases originate from the lumbar facet joints, sufficient therapy strategies must be developed. EFJD offers a precise depiction of the dorsal medial ramus and the facet joint capsule.Methods: In this study, 64 patients who underwent EFJD were included. The main outcome of interest was patients’ Visual Analog Scale (VAS) pain score, which was recorded at 3-time points (i.e., before operation and 6 weeks and 12 months after surgery).Results: EFJD effectively reduced the VAS pain scores by 58% in the short term (6 weeks) and 38% in the long term (12 months). Patients with isolated facet joint osteoarthritis benefited more (<i>p</i> <0.001).Conclusions: EFJD is a good treatment alternative for CLBP originating from the facet joints, particularly in patients with isolated facet joint osteoarthritis. Moreover, this method can address not only the dorsal medial ramus but also the surrounding tissue (e.g., facet joint capsule, facet joint effusion, and osteophytes) as the origin of CLBP.

Spinal Deformity, Surgery at the Cervicothoracic Junction, and American Society of Anesthesiologists Class Increase the Risk of Post-surgical Intensive Care Unit Treatment after Dorsal Spine Surgery: A Single-Center Multivariate Analysis of 962 Patients

Leyendecker Jannik,Prasse Tobias,Rahhal Ahmad Al,Hofstetter Christoph Paul,Wetsch Wolfgang,Eysel Peer,Bredow Jan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.6

Study Design: This was a retrospective multivariate analysis of preoperative risk factors leading to intensive care unit (ICU) admissions in patients undergoing elective or acute dorsal spine surgery.Purpose: Numerous studies have predicted a substantial increase in spine surgeries within the next decades, potentially overwhelming hospitals’ resources, including ICU occupancy. Accurate estimates of whether patients need postsurgical ICU treatment are pivotal for both resource allocation and patient safety.Overview of Literature: Risk factors leading to ICU admissions after dorsal spine surgery have been extensively examined for lumbar elective surgery. Studies including other anatomical segments of the spine and nonelective surgery regarding postsurgical ICU treatment probability are lacking.Methods: This study was designed to be a single-center multivariate analysis of data retrospectively collected from a tertiary care university hospital. Patients undergoing dorsal spine surgery from 2009 to 2019 were included in this study. The patients’ demographic data were analyzed to determine potential preoperative risk factors for ICU admission after surgery using multiple logistic regression.Results: In our cohort, 962 patients with a mean age of 71.1±0.55 years were included. Surgeries involved 3.24±0.08 spinal levels on average. The incidence of ICU treatment after surgery was 30.4% (n=292). Multivariate logistic regression showed a markedly increased odds ratio (OR) for patients undergoing surgery of the cervicothoracic junction (OR, 8.86) and those undergoing surgery for spinal deformity treatment (OR, 7.7). Additionally, cervical procedures (OR, 3.29), American Society of Anesthesiologists (ASA) class 3–4 (OR, 2.74), spondylodiscitis (OR, 2.47), fusion of ≥3 levels (OR, 1.94), and age >75 years (OR, 1.33) were associated with an increased risk of postsurgical ICU admission.Conclusions: The findings highlight the relevance of anatomical location, preoperative diagnosis, ASA class, and length of surgery regarding the predictability of postoperative ICU admission. Our data allowed for more sophisticated estimates regarding the need for ICU treatment after dorsal spine surgery, guiding the surgeon through patient selection, communication, and ICU admission predictability.