BACKGROUND: To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. METHODS: Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. RESULTS: The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar. CONCLUSIONS: When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disk Degeneration/*surgery ; Lordosis/*radiography ; Lumbar Vertebrae/pathology/*radiography/surgery ; Male ; Middle Aged ; Prosthesis Implantation ; Retrospective Studies ; *Spinal Fusion ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery

BACKGROUND: The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. METHODS: Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as > or = a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being > or = 2 mm in the interspinous distance on the flexion-extension lateral radiographs. RESULTS: The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 +/- 1.46 mm and 0.81 +/- 1.27 mm, respectively. Subsidence > or = 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). CONCLUSIONS: Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.
Adult ; Aged ; Biocompatible Materials ; Cervical Vertebrae/pathology/radiography/*surgery ; Diskectomy ; Female ; Humans ; *Internal Fixators ; Intervertebral Disk Degeneration/*surgery ; Ketones ; Male ; Middle Aged ; *Postoperative Complications ; Prosthesis Failure ; Radiculopathy/surgery ; Regression Analysis ; Risk Factors ; Spinal Cord Diseases/surgery ; Spinal Fusion/*methods ; Treatment Outcome

BACKGROUND: We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. METHODS: Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. RESULTS: For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. CONCLUSIONS: PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.
Adult ; Aged ; Blood Loss, Surgical ; Bone Transplantation/*methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disk Degeneration/*radiography/*surgery ; Lumbar Vertebrae/pathology/*radiography/*surgery ; Male ; Middle Aged ; Prosthesis Implantation/methods ; Retrospective Studies ; Spinal Fusion/*methods ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery ; Time and Motion Studies ; Treatment Outcome