Anterior transvertebral interbody cage with posterior transdiscal pedicle screw instrumentation for high-grade spondylolisthesis. Technical note

Indianapolis Neurosurgical Group, Indianapolis, Indiana 46260, USA.
Neurosurgical FOCUS (Impact Factor: 2.11). 02/2006; 20(3):E7. DOI: 10.3171/foc.2006.20.3.8
Source: PubMed


Adult high-grade degenerative spondylolisthesis represents the extreme end of the spectrum for spondylolisthesis and is consequently rarely encountered. Surgical management of high-grade spondylolisthesis requires constructs capable of resisting the shear forces at the slipped L5-S1 interspace. The severity of the slip, sacral inclination, and slip angle may make conventional approaches to 360 degrees fusion difficult or hazardous. Transdiscal pedicle screw fixation, transvertebral fibular graft fusion, and transvertebral cage fixation are techniques that have been developed to establish anterior column load sharing and to resist shear forces at the L5-S1 interspace, given the anatomical constraints accompanying high-grade spondylolisthesis. In this technical note the authors describe the procedure for implanting an in situ anterior L5-S1 transvertebral cage and performing L4-5 anterior lumbar interbody fusion, followed by placement of posterior S1-L5 vertebral body transdiscal pedicle screws for management of high-grade spondylolisthesis.

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Available from: Dean G Karahalios, Jun 14, 2014
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    • "In this study, we found that pain had the most response to surgical treatment as the results of VAS, not with motor weakness and sensory loss, which showed no clinical recovery on a follow-up period, as mentioned in other literatures with good recovery for radicular pain. For recovery of motor weakness and sensory loss might depend on the preoperative duration of symptoms and grading of motor weakness or sensory loss [6,7,10,11]. "
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    ABSTRACT: A retrospective study. To investigate clinical and radiological outcomes when using spinous process as a tricortical autograft for segmental spinal fusion in transforaminal lumbar interbody fusion (TLIF). Interbody spinal fusion is one of the important procedures in spinal surgery. Many types of autografts are harvested at the expense of complications. Clinical and radiographic results of patients who underwent TLIF with intraoperative harvested spinous process autograft in Prasat Neurological Institue, Bangkok, Thailand, were assessed as new technical innovation. Between October 2005 to July 2009, 30 cases of patients who underwent TLIF with spinous process tricortical autograft were included. Clinical evaluations were assessed by visual analog scales (VAS) and Prolo functional and economic scores at the preoperation and postoperation and at 2 years postoperation. Static and dynamic plain radiograph of lumbar spine were reviewed for achievement of fusion. Initial successful fusion time in lumbar interbody fusion with spinous process tricortical autograft was 4.72 months (range, 3.8-6.1 months) postoperation and 100% fusion rate was reported at 2 years. Our initial successful fusion time in lumbar interbody fusion was compared to the other types of grafts in previous literatures. The use of intraoperative harvested spinous process tricortical autograft has overcome many disadvantages of harvesting autograft with better initial successful fusion time (4.72 months). VAS and Prolo scores showed some improvement in the outcomes between the preoperative and postoperative periods.
    Asian spine journal 04/2014; 8(2):170-6. DOI:10.4184/asj.2014.8.2.170
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    • "On the background of such complication rates and also on the basis of biomechanical considerations [3], alternative trans-pedicular trans-discal fixation techniques have been tried. Such trajectories had already been used in combination with pedicle screw and/or transvertebral cage constructs for high dysplastic spondylolistheses [4-10]. Grob and recently Zagra (using the Grob technique) were the first to use 2 trans-pedicular, trans-discal screws alone to stabilize a lumbar or lumbosacral motion segment for posterolateral fusion [11,12]. "
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    ABSTRACT: Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Clinical Trials NCT00810433.
    BMC Musculoskeletal Disorders 09/2010; 11(1):199. DOI:10.1186/1471-2474-11-199 · 1.72 Impact Factor
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    ABSTRACT: Single level axial lumbar interbody fusion (AxiaLIF) using a transsacral rod through a paracoccygeal approach has been developed with promising early clinical results and biomechanical stability. Recently, the transsacral rod has been extended to perform a two-level fusion at both L4–L5 and L5–S1 levels (AxiaLIF II). No biomechanical studies have been conducted on multilevel fusion using the AxiaLIF technique. In this study, the biomechanics of L4–S1 motion segments instrumented with the AxiaLIF II transsacral rod was evaluated. Six human cadaveric lumbosacral spine segments from L4 to S1 were used (age ranges 46–74years). Unconstrained and non-destructive pure moments in axial torsion, lateral bending, and flexion extension were applied to each specimen following intact, standalone AxiaLIF II, and AxiaLIF II with two posterior fixation options: facet screws and pedicle screws with rods. Range of motion was calculated from the raw data collected with an optical motion tracking system. The two-level transsacral rod was successfully inserted in all the specimens. At L4–L5 level in axial torsion (AT) and flexion extension (FE), none of the surgical treatments showed statistically significant difference between the procedures (all P>0.05) although facet screws and pedicle screws had higher stability on average. In lateral bending (LB), the two posterior fixation techniques had significantly higher construct stability (P<0.05) than the standalone rod. No significant difference was found between facet screws and pedicle screws (P=0.821). At L5–S1 level in AT and LB, none of the surgical treatments were found to be statistically significant (all P>0.05). In FE, standalone two-level transsacral rod had significantly higher range of motion (ROM) compared with the posterior fixation techniques (P<0.05). In conclusion, the standalone rod reduced intact ROM significantly. Supplementary fixations including facet screws and pedicle screws are required to achieve higher construct stability for successful fusion. Further clinical studies are essential to evaluate the practical success of this technique.
    European Spine Journal 06/2009; 18(6):807-814. DOI:10.1007/s00586-009-0953-5 · 2.07 Impact Factor
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