Journal of neurosurgery. Spine
-
Comparative Study
Revision of transforaminal lumbar interbody fusion using anterior lumbar interbody fusion: a biomechanical study in nonosteoporotic bone.
Transforaminal lumbar interbody fusion (TLIF) is a popular fusion technique for treating chronic low-back pain. In cases of interbody nonfusion, revision techniques for TLIF include anterior lumbar interbody fusion (ALIF) approaches. Biomechanical data of the revision techniques are not available. The purpose of this study was to compare the immediate construct stability, in terms of range of motion (ROM) and neutral zone (NZ), of a revision ALIF procedure for an unsuccessful TLIF. An in vitro biomechanical comparison of TLIF and its ALIF revision procedure was conducted on cadaveric nonosteoporotic human spine segments. ⋯ Revision ALIF maintained biomechanical stability of TLIF in nonosteoporotic spines. Revision ALIF can be performed without sacrificing spinal stability in cases of intact posterior instrumentation.
-
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance. ⋯ Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine.
-
Meralgia paresthetica (MP) consists of pain or dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (LFCN) underneath the inguinal ligament. The causes include iliac crest bone graft harvesting, seat belt injury associated with motor vehicle accident, diabetes mellitus, and trauma. The authors present the case of a 50-year-old woman who had a 1-year history of right-sided MP. ⋯ The symptoms resolved completely. To the best of the authors' knowledge this is the first case of MP associated with compression caused by a lipoma. The authors conclude that lipoma compression can cause MP, and in such cases, total excision of the lipoma may resolve the condition.
-
The objective of this study was to assess, in patients with degenerative lumbar spondylolisthesis, which factors determine whether the involved disc levels were restabilized or remained unstable at the time of operation using multifactorial analysis. ⋯ Facet effusion size was associated with the determination of whether the affected disc was stabilized or remained unstable at the time of operation. In particular, a smaller facet effusion size strongly suggested that the affected disc had been restabilized in the patients with lumbar degenerative spondylolisthesis.
-
In this paper, the authors' goal was to elucidate the clinical features and results of decompression surgery for extraforaminal stenosis at the lumbosacral junction. ⋯ Extraforaminal stenosis at the lumbosacral junction is a rare but distinct pathological condition causing L-5 radiculopathy. Decompression surgery without fusion using a microendoscope or a surgical microscope/loupe is a feasible and less invasive surgical option for elderly patients with extraforaminal stenosis at the lumbosacral junction.