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5:46 127. Instrumented transforaminal lumbar interbody fusion with titanium mesh cages and iliac crest autograft
66S
Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S
Thursday, September 29, 2005 5:40–6:40 PM SIPP 5: Lumbar Fusion 5:40 126. Minimally invasive transforaminal interbody fusion with percutaneous instrumentation: a prospective evaluation of two year outcomes in 31 patients Mark Grubb, MD, Maureen Kilrain, Nancy Fazekas; Northeast Ohio Spine Center, Canton, OH, USA BACKGROUND CONTEXT: Minimally invasive interbody and pedicle screw instrumentation techniques have become exceedingly popular. Despite the interest and adoption of these techniques there are few published reports of patiet outcomes. PURPOSE: The purpose of this study is to report on surgical, functional, and fusion outcome data from 31 prospectively collected patients treated by minimally invasive unilateral transforaminal interbody fusion (MITLIF) and percutaneous pedicle screw instrumentation. STUDY DESIGN/SETTING: This is a nonrandomized, prospective study of patients treated with a uniform surgical technique by a single surgeon. PATIENT SAMPLE: The patient group consisted of 31 patients, (13 women and 17 men) with a mean age of 54.2 yrs. All patients were taking narcotic medications prior to surgery. All of the patients in this series were treated for single level disease. Slightly over half of the patients (16/31) were working preoperatively. OUTCOME MEASURES: Surgical times, complication rates, and hospital stays were recorded. SF-36, Oswestry, and Low Back Pain Scores were collected. Flexion-Extension radiographs were taken and evaluated at 24 months postoperatively for radiolucency and motion. METHODS: All interbody procedures were performed via a unilateral TLIF procedure. The TLIF component of the procedure was performed through a twenty two-millimeter tubular retractor. Exposure of the disc space through the foramen followed facetectomy. Sub-total discectomy allowed for the interbody cage and bone graft to be placed in a oblique fashion. Bilateral percutaneous pedicle screw instrumentation was then completed. Percutaneous pedicle screw instrumentation was accomplished under EMG and fluoroscopic control. Patients were assessed radiographically and clinically preoperatively and at 3, 6, 12, and 24 months. RESULTS: All of the surgeries in this study were for 1 level intervertebral disease, primarily spondylolisthesis. All of the interbody devices were implated via a unilateral TLIF exposure. The average surgical data were as follows: EBL: 125 cc, 211 min surgical time and hospital stay of 2.2 days. There were 5 complications: 1 csf leak (unrelated to pedicle screw insertion), 1 ileus, 1 right leg numbness (resolved on its own), 1 superficial wound infection and 1 interbody graft retropulsion (required re-operation). Mean Oswestry scores were preop-31.2, 12mos-19.9 and 24mos-18.1. Mean Back pain (VAS-10 point scale) scores were preop-8.8, 12mos-3.2 and 24mos-2.8. Two-thirds of the patients (21/31) were working at 2 years postoperatively. 6/31 patients were retired at 2 years postoperatively. 4/31 were on disability at 2 years. 96.8% (30/31) patients demonstrate rigid fusion on flexion-extension films at 2 years postoperatively. The reoperation rate for this series of patients was 3%. At 24 mos postoperatively 19% (6/31) of patients are taking narcotic medications. Ninty-seven percent (30/31) of patients were satisfied with the outcome of the surgery. CONCLUSIONS: Minimally invasive transforaminal lumbar interbody fusion appears to be safe and effective method for neural decompression and interbody bone grafting in this limited early group of patients. MITLIF offers several advantages to the traditional open technique, including reduction in soft tissue trauma, blood loss, hospital stay, patient perceived level of disability, and the potential for earlier return to function. DISCLOSURES: FDA device/drug: PathFinder Pedicle Screws. Status: Approved for this indication. CONFLICT OF INTEREST: Author (MG) Consultant: Abbott Spine. doi: 10.1016/j.spinee.2005.05.128
5:46 127. Instrumented transforaminal lumbar interbody fusion with titanium mesh cages and iliac crest autograft Jeffrey Coe, MD1, Sang-Heon Lee, MD2; 1Center for Spinal Deformity and Injury, Los Gatos, CA, USA; 2Spinal Diagnostics & Treatment Center, Daly City, CA, USA BACKGROUND CONTEXT: The transforaminal lumbar interbody fusion (TLIF) procedure is an interbody arthrodesis combined with a unilateral posterior (facet and/or interlaminar) arthrodesis with or without a bilateral posterolateral arthrodesis that is stabilized with pedicle screw instrumentation. This procedure is performed through a single midline posterior surgical approach with access to the intervertebral disc is gained by a unilateral resection of the lamina, pars interarticularis and facet joint at the level or levels to be fused. An aggressive discectomy and interbody arthrodesis is then performed unilaterally through this exposure with essentially no retraction of the exiting nerve root and relatively minimal medial retraction of the traversing nerve root and thecal sac (as compared with the posterior lumbar interbody fusion (PLIF) technique). This procedure has been popularized by Harms as alternative to anterior-posterior (“360”) fusion and PLIF. PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results in a consecutive series of patients from one center who underwent instrumented TLIF using titanium mesh cages and iliac crest autograft bone for mechanical low back pain resulting from primarily degenerative conditions. Is the TLIF procedure effective in reducing pain and improving function in patients with chronic mechanical low back pain of degenerative etiology? STUDY DESIGN/SETTING: The clinical and radiographic results of all patients who underwent the TLIF procedure with titanium mesh cages performed by the senior author were evaluated after a minimum of 2 years follow-up. PATIENT SAMPLE: From January 1999 through December 2001, 79 patients underwent the TLIF procedure at one or more levels for mechanical low back pain after a failure of 12 months or more of nonoperative care. 75 patients (94.9%) with a mean age of 45.0 years were followed for two or more years and are the subject of this study. OUTCOME MEASURES: Fusion outcomes were assessed radiographically using AP and lateral radiographs at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years postoperative and flexion-extension lateral radiographs beginning at 6 months postoperative with attention to interbody bone formation and trabeculation of interbody bone anterior to the cages, as well as subsidence of the intervertebral space and motion on the lateral flexion-extension films. Clinical outcomes were measured with the SF-36 instrument administered preoperatively and at 2 years postoperatively. METHODS: See above. RESULTS: At a mean of 39.6 months follow-up (range 26 to 60 months), 74 patients (98.7%) were judged to have solid fusions. Mean 2-year SF-36 pain scores improved to 44.8 from 23.4 (p⬍.001) and physical function scores improved to 55.8 from 35.2 (p⬍.001). Seven patients (9.3%) experienced complications without clinical sequelae. CONCLUSIONS: The clinical and radiographic results of this study demonstrate that the TLIF procedure is both safe and effective in improving both pain and function in patients with chronic mechanical low back pain arising from degenerative lumbar disorders. DISCLOSURES: FDA device/drug: Titanium Mesh Cages. Status: Not approved for this indication. FDA device/drug: Pedicle Screws. Status: Not approved for this indication. CONFLICT OF INTEREST: Author (JC) Consultant: Medtronic Sofamor Danek. doi: 10.1016/j.spinee.2005.05.129 5:52 128. A prospective randomized double blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis
Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S
Thursday, September 29, 2005 5:40–6:40 PM SIPP 5: Lumbar Fusion 5:40 126. Minimally invasive transforaminal interbody fusion with percutaneous instrumentation: a prospective evaluation of two year outcomes in 31 patients Mark Grubb, MD, Maureen Kilrain, Nancy Fazekas; Northeast Ohio Spine Center, Canton, OH, USA BACKGROUND CONTEXT: Minimally invasive interbody and pedicle screw instrumentation techniques have become exceedingly popular. Despite the interest and adoption of these techniques there are few published reports of patiet outcomes. PURPOSE: The purpose of this study is to report on surgical, functional, and fusion outcome data from 31 prospectively collected patients treated by minimally invasive unilateral transforaminal interbody fusion (MITLIF) and percutaneous pedicle screw instrumentation. STUDY DESIGN/SETTING: This is a nonrandomized, prospective study of patients treated with a uniform surgical technique by a single surgeon. PATIENT SAMPLE: The patient group consisted of 31 patients, (13 women and 17 men) with a mean age of 54.2 yrs. All patients were taking narcotic medications prior to surgery. All of the patients in this series were treated for single level disease. Slightly over half of the patients (16/31) were working preoperatively. OUTCOME MEASURES: Surgical times, complication rates, and hospital stays were recorded. SF-36, Oswestry, and Low Back Pain Scores were collected. Flexion-Extension radiographs were taken and evaluated at 24 months postoperatively for radiolucency and motion. METHODS: All interbody procedures were performed via a unilateral TLIF procedure. The TLIF component of the procedure was performed through a twenty two-millimeter tubular retractor. Exposure of the disc space through the foramen followed facetectomy. Sub-total discectomy allowed for the interbody cage and bone graft to be placed in a oblique fashion. Bilateral percutaneous pedicle screw instrumentation was then completed. Percutaneous pedicle screw instrumentation was accomplished under EMG and fluoroscopic control. Patients were assessed radiographically and clinically preoperatively and at 3, 6, 12, and 24 months. RESULTS: All of the surgeries in this study were for 1 level intervertebral disease, primarily spondylolisthesis. All of the interbody devices were implated via a unilateral TLIF exposure. The average surgical data were as follows: EBL: 125 cc, 211 min surgical time and hospital stay of 2.2 days. There were 5 complications: 1 csf leak (unrelated to pedicle screw insertion), 1 ileus, 1 right leg numbness (resolved on its own), 1 superficial wound infection and 1 interbody graft retropulsion (required re-operation). Mean Oswestry scores were preop-31.2, 12mos-19.9 and 24mos-18.1. Mean Back pain (VAS-10 point scale) scores were preop-8.8, 12mos-3.2 and 24mos-2.8. Two-thirds of the patients (21/31) were working at 2 years postoperatively. 6/31 patients were retired at 2 years postoperatively. 4/31 were on disability at 2 years. 96.8% (30/31) patients demonstrate rigid fusion on flexion-extension films at 2 years postoperatively. The reoperation rate for this series of patients was 3%. At 24 mos postoperatively 19% (6/31) of patients are taking narcotic medications. Ninty-seven percent (30/31) of patients were satisfied with the outcome of the surgery. CONCLUSIONS: Minimally invasive transforaminal lumbar interbody fusion appears to be safe and effective method for neural decompression and interbody bone grafting in this limited early group of patients. MITLIF offers several advantages to the traditional open technique, including reduction in soft tissue trauma, blood loss, hospital stay, patient perceived level of disability, and the potential for earlier return to function. DISCLOSURES: FDA device/drug: PathFinder Pedicle Screws. Status: Approved for this indication. CONFLICT OF INTEREST: Author (MG) Consultant: Abbott Spine. doi: 10.1016/j.spinee.2005.05.128
5:46 127. Instrumented transforaminal lumbar interbody fusion with titanium mesh cages and iliac crest autograft Jeffrey Coe, MD1, Sang-Heon Lee, MD2; 1Center for Spinal Deformity and Injury, Los Gatos, CA, USA; 2Spinal Diagnostics & Treatment Center, Daly City, CA, USA BACKGROUND CONTEXT: The transforaminal lumbar interbody fusion (TLIF) procedure is an interbody arthrodesis combined with a unilateral posterior (facet and/or interlaminar) arthrodesis with or without a bilateral posterolateral arthrodesis that is stabilized with pedicle screw instrumentation. This procedure is performed through a single midline posterior surgical approach with access to the intervertebral disc is gained by a unilateral resection of the lamina, pars interarticularis and facet joint at the level or levels to be fused. An aggressive discectomy and interbody arthrodesis is then performed unilaterally through this exposure with essentially no retraction of the exiting nerve root and relatively minimal medial retraction of the traversing nerve root and thecal sac (as compared with the posterior lumbar interbody fusion (PLIF) technique). This procedure has been popularized by Harms as alternative to anterior-posterior (“360”) fusion and PLIF. PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results in a consecutive series of patients from one center who underwent instrumented TLIF using titanium mesh cages and iliac crest autograft bone for mechanical low back pain resulting from primarily degenerative conditions. Is the TLIF procedure effective in reducing pain and improving function in patients with chronic mechanical low back pain of degenerative etiology? STUDY DESIGN/SETTING: The clinical and radiographic results of all patients who underwent the TLIF procedure with titanium mesh cages performed by the senior author were evaluated after a minimum of 2 years follow-up. PATIENT SAMPLE: From January 1999 through December 2001, 79 patients underwent the TLIF procedure at one or more levels for mechanical low back pain after a failure of 12 months or more of nonoperative care. 75 patients (94.9%) with a mean age of 45.0 years were followed for two or more years and are the subject of this study. OUTCOME MEASURES: Fusion outcomes were assessed radiographically using AP and lateral radiographs at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years postoperative and flexion-extension lateral radiographs beginning at 6 months postoperative with attention to interbody bone formation and trabeculation of interbody bone anterior to the cages, as well as subsidence of the intervertebral space and motion on the lateral flexion-extension films. Clinical outcomes were measured with the SF-36 instrument administered preoperatively and at 2 years postoperatively. METHODS: See above. RESULTS: At a mean of 39.6 months follow-up (range 26 to 60 months), 74 patients (98.7%) were judged to have solid fusions. Mean 2-year SF-36 pain scores improved to 44.8 from 23.4 (p⬍.001) and physical function scores improved to 55.8 from 35.2 (p⬍.001). Seven patients (9.3%) experienced complications without clinical sequelae. CONCLUSIONS: The clinical and radiographic results of this study demonstrate that the TLIF procedure is both safe and effective in improving both pain and function in patients with chronic mechanical low back pain arising from degenerative lumbar disorders. DISCLOSURES: FDA device/drug: Titanium Mesh Cages. Status: Not approved for this indication. FDA device/drug: Pedicle Screws. Status: Not approved for this indication. CONFLICT OF INTEREST: Author (JC) Consultant: Medtronic Sofamor Danek. doi: 10.1016/j.spinee.2005.05.129 5:52 128. A prospective randomized double blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis