Dataset Information

The Concept for A Standalone Lordotic Endoscopic Wedge Lumbar Interbody Fusion: The LEW-LIF.

ABSTRACT:

Objective

To review concepts of a standalone endoscopically assisted lumbar interbody fusion as a simplified method to treat spinal instability.

Methods

MacNab outcomes and complications were analyzed in a series of 48 consecutive patients who underwent standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF) for advanced lumbar disc degeneration, spinal stenosis, and spondylolisthesis.

Results

Forty-two of the 48 patients (77.8%) did well with excellent and good outcomes with a follow up of up to 20 months. Fair outcomes were reported by 4, and poor by another 2 patients, respectively. Six patients had endoscopic decompression procedures at another level. Four patients underwent open transforaminal lumbar interbody fusion revision surgery including the index level between 2 to 6 months postoperatively. An L5 vertebral body fracture was noted in 1 of these 4 patients. Another patient underwent removal of the extruded L3/4 cage. The cage fractured in one additional asymptomatic patient not requiring any intervention. No patient had a wound infection, or permanent sensory, or motor dysfunction. However, 29 patients developed a postoperative irritation of the dorsal root ganglion with burning leg pain typically between postoperative weeks 2 and 6. Symptoms were treated with activity modification, gabapentin, and transforaminal epidural steroid injections in 12 patients (25%).

Conclusion

Standalone LEW-LIF was associated with favorable clinical outcomes in the majority of patients. Patient-related predictors of less favorable outcomes considering normal variations as well as patho-anatomy may aid in the development of next-generation implants.

SUBMITTER: Lewandrowski KU

PROVIDER: S-EPMC6449821 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The Concept for A Standalone Lordotic Endoscopic Wedge Lumbar Interbody Fusion: The LEW-LIF.

Lewandrowski Kai-Uwe KU Ransom Nicholas A NA Ramírez León Jorge Felipe JF Yeung Anthony A

Neurospine 20190331 1

<h4>Objective</h4>To review concepts of a standalone endoscopically assisted lumbar interbody fusion as a simplified method to treat spinal instability.<h4>Methods</h4>MacNab outcomes and complications were analyzed in a series of 48 consecutive patients who underwent standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF) for advanced lumbar disc degeneration, spinal stenosis, and spondylolisthesis.<h4>Results</h4>Forty-two of the 48 patients (77.8%) did well with excellent and g ...[more]

PMID: 30943710

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Project description:Background:A diseased lumbar intervertebral vacuum disc void of any structurally intact tissue may be vertically unstable. A primary standalone endoscopic decompression and interbody fusion surgery in the treatment of vertical instability in patients with a vacuum disc may be a more reliable treatment than decompression alone. Methods:The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups on social media networks, including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive and correlative statistics were employed to count the responses and compare the surgeon's responses recorded on a Likert scale from 1 (disagree) to 10 (agree) or in multiple-choice questions. Surgeons were asked about their familiarity with the concept of vacuum disc and vertical instability and how they would treat such patients. Kappa statistics and linear regression analysis of agreement of incoming responses were performed. Results:A total of 1,165 surgeons accessed the survey. The completion rate was 22.78. The majority surgeons were very familiar with the concept of a "vacuum disc" as a sign of end-stage lumbar degenerative disc disease and a collapsing lumbar motion segment (182/273; 66.7%; Likert score 6.53). The majority of surgeons also thought that vertical instability precedes anterolateral lumbar instability (187/273; 68.5%; Likert score 6.64) and that a vacuum disc may cause vertical instability with symptomatic dynamic foraminal & lateral recess stenosis (222/273; 81%; Likert score 7.48), mechanical back pain (201/273; 73.1%; Likert score 7.48), and may cause sciatica-type low back and leg pain (179/273; 66.3%; Likert score 6.59). The majority of surgeons indicated that vacuum phenomenon on radiographic studies is associated with vertical instability and collapse resulting in dynamic foraminal and lateral recess stenosis and should be treated surgically (199/266; 73.7%; 7 missing responses; Likert score 6.86). Preferred treatments were decompression alone without fusion (P<0.014). There was consensus in support of fusion by TLIF or PLIF with a Likert score of 6.68 (184/266; 69.2%; 7 missing responses). There was no consensus on standalone fusion. Conclusions:Vacuum phenomenon on radiographic studies is associated with a vertical instability and collapse, resulting in dynamic foraminal and lateral recess stenosis that should be treated surgically. Preferred surgical treatments were decompression alone, decompression with interbody fusion using just bone graft, and fusion employing TLIF or PLIF. Further research into the clinical significance of lumbar vacuum disc, vertical instability and its most appropriate surgical treatments if any is necessary.

Project description:We report a case of subsidence induced recurrence of unilateral L5 and S1 radiculopathy six months following a successful staged two-level endoscopic standalone lumbar interbody fusion using the VARILIF-L™ device. The patient was a 64-year-old female who first underwent outpatient endoscopic fusion L4/5 for failed non-operative care of Grade I spondylolisthesis. Within 11 months from the L4/5 index procedure, she developed symptomatic adjacent segment disease stemming from the L5/S1 level. A preoperative computed tomography before the planned L5/S1 endoscopic standalone VARILIF™ fusion 15 months following her L4/5 VARILIF™ procedure revealed fusion at the L4/5 level with minimal subsidence of the VARILIF-L™ implant, and advanced degeneration of the L5/S1 motion segment with lateral recess and foraminal stenosis, reduced posterior disc height, and vacuum disc. The patient underwent uneventful L5/S1 endoscopic standalone fusion using the VARILIF-L™ implant with successful clinical outcome and resolution of back and leg symptoms. Six months after the second endoscopic L5/S1 VARILIF™ procedure she developed recurrent L5 and S1 radiculopathy. Computed tomography showed significant implant subsidence and formation of a large soft tissue bulge on the approach side behind the interbody fusion cage. The subsidence induced subsidence and loss of posterior disc height and the associated recurrence of nerve root compression of the traversing S1 and exiting L5 nerve root. The recurrent radiculopathy was eventually treated with another transforaminal endoscopic decompression which included a more generous foraminoplasty with resection of the remaining superior articular process including a partial S1 pediculectomy and additional resection of the posterior annulus as well as scar and bony tissue that had formed within the axillary hidden zone of Macnab. We concluded that recurrent radiculopathy might occur after standalone lumbar transforaminal endoscopic interbody fusion with an expandable threaded cylindrical cage as a result of vertical and angular subsidence.

Project description:This meta-analysis aims to determine the clinical outcomes, complications, and fusion rates in endoscopic assisted intra-foraminal lumbar interbody fusion (iLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative diseases. The MEDLINE, Embase, and Cochrane Library databases were searched. The inclusion criteria were: five or more consecutive patients who underwent iLIF or MI-TLIF for lumbar degenerative diseases; description of the surgical technique; clinical outcome measures, complications and imaging assessment; minimum follow-up of 12 months. Surgical time, blood loss, and length of hospital stay were extracted. Mean outcome improvements were pooled and compared with minimal clinically important differences (MCID). Pooled and direct meta-analysis were evaluated. We identified 42 eligible studies. The iLIF group had significantly lower mean intra-operative blood loss, unstandardized mean difference (UMD) 110.61 mL (95%CI 70.43; 150.80; p value < 0.0001), and significantly decreased length of hospital stay (UMD 2.36; 95%CI 1.77; 2.94; p value < 0.0001). Visual analogue scale (VAS) back, VAS leg and Oswestry disability index (ODI) baseline to last follow-up mean improvements were statistically significant (p value < 0.0001), and clinically important for both groups (MCID VAS back > 1.16; MCID VAS leg > 1.36; MCID > 12.40). There was no significant difference in complication nor fusion rates between both cohorts. Interbody fusion using either iLIF or MI-TLIF leads to significant and clinically important improvements in clinical outcomes for lumbar degenerative diseases. Both procedures provide high rates of fusion at 12 months or later, without significant difference in complication rates. iLIF is associated with significantly less intraoperative blood loss and length of hospital stay. Study registration: PROSPERO international prospective register of systematic reviews: Registration No. CRD42020180980, accessible at https://www.crd.york.ac.uk/prospero/ April 2020.

Dataset Information

The Concept for A Standalone Lordotic Endoscopic Wedge Lumbar Interbody Fusion: The LEW-LIF.

Objective

Methods

Results

Conclusion

Publications

The Concept for A Standalone Lordotic Endoscopic Wedge Lumbar Interbody Fusion: The LEW-LIF.

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