Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique
Abstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a s...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-12-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-023-00741-3 |
| _version_ | 1827581452071469056 |
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| author | Marcello Ferraro Francesco Puglia Andrea Della Valle Vincenzo Cerbone Alfonso Cicatelli Donata Rita Peroni Davide Cecconi Bernardo Misaggi Giovanni Andrea La Maida |
| author_facet | Marcello Ferraro Francesco Puglia Andrea Della Valle Vincenzo Cerbone Alfonso Cicatelli Donata Rita Peroni Davide Cecconi Bernardo Misaggi Giovanni Andrea La Maida |
| author_sort | Marcello Ferraro |
| collection | DOAJ |
| description | Abstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of < 5 mm. The average follow-up duration was 30 months. Results We achieved excellent clinical results, with only four cases of failure (5.2%). Moreover, we noticed a statistically significant redistribution of lumbar lordosis, with an average percentage increase in L4–S1 lordosis equal to 19.9% (P < 0.001), an average increase in the L4–S1/Lumbar lordosis (LL) ratio from 0.53 to 0.63 (P < 0.001), and a mean percentage increase in sacral slope equal to 7.6% (P < 0.001). Conclusion Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures. Level of evidence: 4 Trial registration statement: retrospective observational study, no trial registration. |
| first_indexed | 2024-03-08T22:36:39Z |
| format | Article |
| id | doaj.art-aa2e8601db7644c7b04cf45f5c6b0be8 |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-03-08T22:36:39Z |
| publishDate | 2023-12-01 |
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| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-aa2e8601db7644c7b04cf45f5c6b0be82023-12-17T12:26:43ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992023-12-012411810.1186/s10195-023-00741-3Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior techniqueMarcello Ferraro0Francesco Puglia1Andrea Della Valle2Vincenzo Cerbone3Alfonso Cicatelli4Donata Rita Peroni5Davide Cecconi6Bernardo Misaggi7Giovanni Andrea La Maida8Spine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniSpine Surgery Department, Orthopaedic Institute Gaetano PiniAbstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of < 5 mm. The average follow-up duration was 30 months. Results We achieved excellent clinical results, with only four cases of failure (5.2%). Moreover, we noticed a statistically significant redistribution of lumbar lordosis, with an average percentage increase in L4–S1 lordosis equal to 19.9% (P < 0.001), an average increase in the L4–S1/Lumbar lordosis (LL) ratio from 0.53 to 0.63 (P < 0.001), and a mean percentage increase in sacral slope equal to 7.6% (P < 0.001). Conclusion Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures. Level of evidence: 4 Trial registration statement: retrospective observational study, no trial registration.https://doi.org/10.1186/s10195-023-00741-3TantalumCageLumbar lordosisTLIFInterbody fusion |
| spellingShingle | Marcello Ferraro Francesco Puglia Andrea Della Valle Vincenzo Cerbone Alfonso Cicatelli Donata Rita Peroni Davide Cecconi Bernardo Misaggi Giovanni Andrea La Maida Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique Journal of Orthopaedics and Traumatology Tantalum Cage Lumbar lordosis TLIF Interbody fusion |
| title | Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| title_full | Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| title_fullStr | Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| title_full_unstemmed | Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| title_short | Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| title_sort | transforaminal lumbar interbody fusion with a tantalum cage lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique |
| topic | Tantalum Cage Lumbar lordosis TLIF Interbody fusion |
| url | https://doi.org/10.1186/s10195-023-00741-3 |
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