European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were selected to conservative treatment. Under fluoroscopy in the posterior-lateral position, a K-wire was advanced into the intervertebral space and a dilator and working cannula were introduced into the disc space step by step. ⋯ The values of Visual Analog Scale (VAS) on movement and Oswestry Disability Index (ODI) dropped by more than 80 and 67.4%, respectively. Disk space heights averaging 9.0 mm before procedure were increased to 11.5 mm 1 month (a significant difference compared with preprocedure, P < 0.01) after surgery and stabilized at 10.8 mm upon final follow-up (a significant difference compared with preprocedure, P < 0.01). The results demonstrated that the percutaneous approach for posterior-lateral lumbar interbody fusion using expandable spinal system is a valuable micro-invasion method for the DDD patients and can achieve the same outcome as with other methods.
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The goal of this study was to assess surgical clinical and radiographic outcomes of using a posterior transpedicular approach (posterolateral) for ventral malignant tumors of the cervical spine. Access to ventral lesions of the cervical spine can be challenging in patients with malignant tumors. Anterior approaches are the gold standard for ventral pathology in the cervical spine, however, there are cases, where a posterior approach is indicated due to multilevel disease, previous radiation, swallowing difficulty with difficulty in retraction of trachea and esophagus, and in cases where circumferential fusion cannot be done due to patients' poor medical condition. ⋯ In two patients the vertebral artery was ligated without sequelae. We conclude that cervical spine transpedicular (posterolateral) approach is useful in cases where an anterior approach or a circumferential approach is not an option. It avoids the morbidity of anterior transcervical, transternal, and transoral procedures while providing decompression of neural elements and allowing three column stabilization when needed.