Tag: Lumbar arthrodesis

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Interbody cages versus structural bone grafts in lumbar arthrodesis: a systematic review and meta-analysis

J Neurosurg Spine 41:188–198, 2024

The role of interbodies in lumbar arthrodesis has been insufficiently supported by evidence, impacting clinical decision-making and occasionally insurance coverage. This study aimed to compare clinical and radiological outcomes between lumbar arthrodesis with a synthetic interbody spacer (cage) versus structural bone graft alone (autograft or allograft) in patients with degenerative spine disease.

METHODS A systematic review of the literature was performed to identify studies directly comparing outcomes of lumbar interbody arthrodesis with and without interbody cage use. The outcomes of individual studies were synthesized in meta-analyses using random-effects models.

RESULTS Twenty studies with 1508 patients (769 with an interbody cage and 739 without an interbody cage) were included. Interbody cage placement was associated with a significantly greater increase in disc height after surgery (4.0 mm vs 3.4 mm, p < 0.01). There was a significantly greater reduction of back pain (visual analog scale [VAS] score) in cases in which an interbody cage was used (5.4 vs 4.7, p = 0.03). Fusion rates were 5.5% higher in the cage group (96.3% vs 90.8%) and reached statistical significance (p = 0.03). No statistically significant differences were identified between the two groups regarding all-cause reoperation rates, complication rates, or improvement in Oswestry Disability Index score or leg pain (VAS score).

CONCLUSIONS These results suggest that implantation of an interbody cage is associated with higher rates of fusion, more effective maintenance of disc height, and greater improvement of back pain. This study underlines the clinical value of interbody cages in lumbar arthrodesis for patients with degenerative spine disease.

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Midline lumbar interbody fusion (MIDLIF) with cortical screws

Acta Neurochirurgica (2019) 161:2415–2420

A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team’s initial learning period.

Methods The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients’ demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment.

Results Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient’s order number (r = − 0.539, p = 0.002).

Conclusions In our initial experience, MIDLIF showed to be effective in significantly improving the patients’ functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.

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