Pseudarthrosis Following Lumbar and Lumbosacral Fusion Using the Antepsoas Technique.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Dec 2021
15 Dec 2021
Historique:
pubmed:
3
9
2021
medline:
27
11
2021
entrez:
2
9
2021
Statut:
ppublish
Résumé
Retrospective case-control study. The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions. Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis. This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1-4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis. A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were "definitely fused" and 40 levels [5.8%] were "Likely fused") and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were "likely not fused" and five levels (0.7%) were "definitely not fused"). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0-2%). Of 127 smokers, six developed pseudarthrosis (odds ratio = 2.3, P = 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients). The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers.Level of Evidence: 4.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective case-control study.
OBJECTIVE
OBJECTIVE
The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis.
METHODS
METHODS
This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1-4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis.
RESULTS
RESULTS
A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were "definitely fused" and 40 levels [5.8%] were "Likely fused") and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were "likely not fused" and five levels (0.7%) were "definitely not fused"). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0-2%). Of 127 smokers, six developed pseudarthrosis (odds ratio = 2.3, P = 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients).
CONCLUSION
CONCLUSIONS
The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers.Level of Evidence: 4.
Identifiants
pubmed: 34474451
doi: 10.1097/BRS.0000000000004115
pii: 00007632-202112150-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1690-1695Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Williams AL, Gornet MF, Burkus JK. CT evaluation of lumbar interbody fusion: current concepts. Am J Neuroradiol 2005; 26:2057–2066.
Myers ME, Spits DJ. Fusion Analysis on CT Spine Exams. 2015. /paper/Fusion-Analysis-on-CT-Spine-Exams-Myers-Spitz/8d131dee2524098fe83ec9c6c8dbfc454e61529f. Accessed July 20, 2020.
Chun DS, Baker KC, Hsu WK. Lumbar pseudarthrosis: a review of current diagnosis and treatment. Neurosurg Focus 2015; 39:E10.
Christensen FB, Hansen ES, Eiskjaer SP, et al. Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine 2002; 27:2674–2683.
Lenke LG, Edwards CC, Bridwell KH. The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 2003; 28:S199–S207.
Nakashima H, Yukawa Y, Ito K, et al. Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion. Eur Spine J 2011; 20:1496–1502.
Sandhu H, Zdeblick T, Foley K, et al. 9:43 Spinal fusion and smoking. Spine J 2002; 2:82–83.
Tannoury T, Kempegowda H, Haddadi K, et al. Complications associated with minimally invasive anterior to the psoas (ATP) fusion of the lumbosacral spine. Spine (Phila Pa 1976) 2019; 44:E1122–E1129.
Lykissas M, Gkiatas I. Use of recombinant human bone morphogenetic protein-2 in spine surgery. World J Orthop 2017; 8:531–535.
Singh K, Nandyala SV, Marquez-Lara A, et al. Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Spine J 2013; 13:1118–1125. doi: 10.1016/j.spinee.2013.07.028.
doi: 10.1016/j.spinee.2013.07.028
Anderson DG, Sayadipour A, Shelby K, et al. Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine. Eur Spine J 2011; 20:1323–1330.
Greene AC, Hsu WK. Orthobiologics in minimally invasive lumbar fusion. J Spine Surg 2019; 5: (suppl): S11–S18.
Tannoury CA, An HS. Complications with the use of bone morphogenetic protein 2 (BMP-2) in spine surgery. Spine J 2014; 14:552–559.
Chen Y-C, Lee C-Y, Chen S-J. Narcotic addiction in failed back surgery syndrome. Cell Transplant 2019; 28:239–247.
Hollern DA, Woods BI, Shah NV, et al. Risk factors for pseudarthrosis after surgical site infection of the spine. Int J Spine Surg 2019; 13:507–514.
Tannoury C, Tannoury T. Anterolateral retroperitoneal psoas-sparing (anterior to psoas: ATP) lumbar interbody fusion for degenerative spine and adult deformity: surgical technique and the evidence. Semin Spine Surg 2018; 30:237–246.
Chang KY, Hsu WK. Spinal biologics in minimally invasive lumbar surgery. Minim Invasive Surg 2018; 2018:5230350.
Strube P, Hoff E, Hartwig T, et al. Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months. J Spinal Disord Tech 2012; 25:362–369.
Berjano P, Langella F, Damilano M, et al. Fusion rate following extreme lateral lumbar interbody fusion. Eur Spine J 2015; 24 suppl 3:369–371.
Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results. Spine (Phila Pa 1976) 1993; 18:983–991.
Høy K, Bunger C, Niederman B, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up. Eur Spine J 2013; 22:2022–2029.
Fujimori T, Le H, Schairer WW, et al. Does transforaminal lumbar interbody fusion have advantages over posterolateral lumbar fusion for degenerative spondylolisthesis? Global Spine J 2015; 5:102–109.
Hsu WK, Nickoli MS, Wang JC, et al. Improving the clinical evidence of bone graft substitute technology in lumbar spine surgery. Global Spine J 2012; 2:239–248. doi: 10.1055/s-0032-1315454.
doi: 10.1055/s-0032-1315454
Emami A, Faloon M, Sahai N, et al. Risk factors for pseudarthrosis in minimally-invasive transforaminal lumbar interbody fusion. Asian Spine J 2018; 12:830–838. https://doi.org/10.31616/asj.2018.12.5.830
doi: 10.31616/asj.2018.12.5.830
Elsevier, Steinmetz MP, Benzel EC, Apfelbaum RI. Subsidence and dynamic cervical spine stabilization. Spine Surgery 2005; 1477–1485.