Tag: Indications

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Outcomes of Anterior Lumbar Interbody Fusion Surgery Based on Indication: A Prospective Study

Outcomes of Anterior Lumbar Interbody Fusion Surgery Based on Indication- A Prospective Study

Neurosurgery 76:7–24, 2015

There is limited information on clinical outcomes after anterior lumbar interbody fusion (ALIF) based on the indications for surgery.

OBJECTIVE: To compare the clinical and radiological outcomes of ALIF for each surgical indication.

METHODS: This prospective clinical study included 125 patients who underwent ALIF over a 2-year period. The patients were evaluated preoperatively and postoperatively. Outcome measures included the Short Form-12, Oswestry Disability Index, Visual Analog Scale, and Patient Satisfaction Index.

RESULTS: After a mean follow-up of 20 months, the clinical condition of the patients was significantly better than their preoperative status across all indications. A total of 108 patients had a Patient Satisfaction Index score of 1 or 2, indicating a successful clinical outcome in 86%. Patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and scoliosis had the best clinical response to ALIF, with statistically significant improvement in the Short Form-12, Oswestry Disability Index, and Visual Analog Scale. Failed posterior fusion and adjacent segment disease showed statistically significant improvement in all of these clinical outcome scores, although the mean changes in the Short Form-12 Mental Component Summary, Oswestry Disability Index, and Visual Analog Scale (back pain) were lower. The overall radiological fusion rate was 94.4%. Superior radiological outcomes (fusion .90%) were observed in patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and failed posterior fusion, whereas in adjacent segment disease, it was 80%.

CONCLUSION: ALIF is an effective treatment for degenerative disk disease (with and without radiculopathy) and spondylolisthesis. Although results were promising for scoliosis, failed posterior fusion, and adjacent segment disease, further studies are necessary to establish the effectiveness of ALIF in these conditions.

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Lateral Extracavitary vs Costotransversectomy Approaches to the Thoracic Spine

Lateral Extracavitary vs Costotransversectomy Approaches to the Thoracic Spine- Reflections on Lessons Learned Lateral Extracavitary vs Costotransversectomy Approaches to the Thoracic Spine- Reflections on Lessons Learned_2

Neurosurgery 71:1096–1102, 2012

The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature.

OBJECTIVE: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine.

METHODS: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution.

RESULTS: A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P = .002). Mean blood loss was 2134 mL and 1556 mL (P = .3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P = .07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P = 1.0) had preoperative or postoperative complications.

CONCLUSION: LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.

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