Facet Joint Fixation and Anterior, Direct Lateral, and Transforaminal Lumbar Interbody Fusions for Treatment of Degenerative Lumbar Disc Diseases: Retrospective Cohort Study of a New Minimally Invasive Technique

Evgenii Belykh, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Andrey A. Kalinin, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Irkutsk Railway Clinical Hospital, Irkutsk, Russia.
Nikolay L. Martirosyan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Talgat Kerimbayev, Department of Spinal Surgery and Pathology of Peripheral Nervous System, JSC "National Center of Neurosurgery", Astana, Kazakhstan.
Nicholas Theodore, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Mark C. Preul, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Vadim A. Byvaltsev, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Irkutsk Railway Clinical Hospital, Irkutsk, Russia. Electronic address: Neuropub@dignityhealth.org.

Document Type

Article

Abstract

BACKGROUND: Anterior, direct lateral, and transforaminal lumbar interbody fusions (ALIF, DLIF, and TLIF) are usually combined with posterior fixation to treat degenerative spinal diseases. Outcomes of ALIF, TLIF, or DLIF combined with a new wedge-shaped interfacet cage plate have not been reported. We assessed early clinical outcomes of patients treated with interbody fusion and facet fixation using a titanium wedge-shaped cage plate. METHODS: This retrospective observational cohort study included patients (n = 80) who underwent 1-level interbody fusion and facet joint fixation via ALIF (n = 24) or DLIF (n = 26) with bilateral facet fixation or TLIF with ipsilateral pedicle screws and contralateral facet fixation (n = 30). Duration of surgery, estimated blood loss, pain (visual analog scale), Oswestry Disability Index (ODI) scores, and Macnab score were assessed up to 12 months after surgery. RESULTS: All patients had a significant decrease in pain scores (P < 0.01) and an increase in ODI scores (P < 0.01), without significant differences between treatment groups. Most surgical outcomes were excellent or good (n = 75, 93.8%) with 5 patients (6.2%) having satisfactory outcomes. Within 2 months, all patients returned to their previous work (66, 82.5%) or lighter work (14, 17.5%). Two patients had fusion failure requiring reoperation. CONCLUSIONS: Facet fixation with the wedge-shaped cage plate was associated with minimal soft tissue damage and a low level of postoperative pain. ALIF, DLIF, and TLIF combined with this technique showed good early postoperative clinical and radiologic outcomes. Further studies are needed to assess long-term results and compare them with other fusion methods.

Medical Subject Headings

Adult; Cohort Studies; Female; Humans; Internal Fixators; Intervertebral Disc Degeneration (diagnostic imaging, surgery); Intervertebral Disc Displacement (diagnostic imaging, surgery); Lumbar Vertebrae (diagnostic imaging, surgery); Male; Middle Aged; Minimally Invasive Surgical Procedures (instrumentation, methods); Prospective Studies; Retrospective Studies; Spinal Fusion (instrumentation, methods); Treatment Outcome; Zygapophyseal Joint (diagnostic imaging, surgery)

Publication Date

6-1-2018

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

114

First Page

e959

Last Page

e968

PubMed ID

29588241

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.03.121

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