Prospective Comparative Study of Clinical and Radiological Outcome of Open versus Minimal Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease

Vol. 9 | Issue 1 | January-February 2021 | Page: 08-13 | Mohan N S, Vijay Vithal Mundewadi, H S Chandrashekar


Authors: Mohan N S [1], Vijay Vithal Mundewadi [1], H S Chandrashekar [1]

[1] Department of Orthopaedics, Sanjay Gandhi Institute of Trauma And Orthopaedics, Byrasandra, Jayanagar East, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. Vijay V. Mundewadi,
Junior Resident, Department of Orthopaedics, Sanjay
Gandhi Institute of Trauma And Orthopaedics,
Bengaluru, Karnataka, India.
E-mail: vijayvithalmundewadi@gmail.com

 


Abstract


Objectives: Clinical outcome of degenerative lumbar spine disease treated by minimal invasive and open TLIF assessed by visual analog score and Oswestry Disability Index and to compare radiological outcome by Bridwell interbody fusion grading, Cobb’s angle and to compare intraoperative blood loss, length of hospital stay, and duration of surgery between the two groups.
Materials and Methods: A prospective comparative study of 50 patients with degenerative lumbar spine disease with Grade I spinal canal stenosis, spondylolisthesis Grades II and III were treated with minimal invasive TLIF and open TLIF at the Department of Spine Surgery, Sanjay Gandhi Institute of Trauma and Orthopaedic, Bengaluru, from June 2019 to June 2020. Clinical assessment was done with VAS and ODI score system and radiological assessment was done with Cobb’s angle, Bridwell interbody fusion grading system. Patients were divided into two groups according to the surgical method used. In Group A, 25 patients underwent minimal invasive TLIF M. In Group B, 25 patients underwent open TLIF. Clinical and radiological parameters were evaluated before surgery, after surgery, 3 months, 6 months, and 1 year after surgery.
Results: Our study had predominant female population. Predominant age group was 45–55 years, who had degenerative lumbar spine disease. The most common degenerative disease was spondylolisthesis. Majority of the patients had L4–L5 level involvement. VAS at the end of 12 months was 1.6 and 2.5 for M–TLIF and O–TLIF, respectively. ODI scores at the end of 12 months where 13.8 and 19.2, respectively, for M–TLIF and O–TLIF. Average hospital stay was 5.4 and eight, respectively, for minimally invasive transforaminal lumbar interbody fusion (M-TLIF) and open TLIF (O-TLIF). M-TLIF had less blood loss then O-TLIF. There was no statistical difference in the Bridwell fusion grading between the two groups.
Conclusion: M-TLIF provides patients a safe option for lumbar fusion, and the technique is comparable to open TLIF with similar operating time, equivalent clinical and radiological outcomes, and comparable complication rates. In addition, M-TLIF patients do have significant advantages over open TLIF patients in terms of perioperative outcomes, such as less blood loss and pain, earlier ambulation, and discharge from hospital.
Keywords: Degenerative lumbar spine disease, Open transforaminal lumbar interbody fusion, Minimally invasive transforaminal lumbar interbody fusion, Spondylolisthesis, Spinal canal stenosis.

 


References


1. Peng CW, Yue WM, Poh SY, Yeo W, Tan SB. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 2009;34:1385-9.
2. Burneikiene S, Roeca C, Nelson L, Mason A, Villavicencio A. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 2010;1:12.
3. Li Y, Wang X, Yan H, Hao D, Liu Z. The long-term clinical effect of minimal-invasive TLIF technique in 1-segment lumbar disease. Clin Spine Surg 2017;30:E713-9.
4. Kulkarni A, Bohra H, Dhruv A, Sarraf A, Bassi A, Patil V. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion. Indian J Orthop 2016;50:464.
5. Ge DH, Stekas ND, Varlotta CG, Fischer CR, Petrizzo A, Protopsaltis TS, et al. Comparative analysis of two transforaminal lumbar interbody fusion techniques. Spine 2019;44:E555-60.
6. Canale ST. Campbell’s Operative Orthopaedics. 13th ed. Netherlands: Elsevier; 1939.
7. Rhee JM. Operative Techniques in Spine Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
8. Aebi M. AO Spine Manual. United States: Thieme; 2007.
9. Ramani PS. Textbook of Spinal Surgery. United States: Lippincott Williams & Wilkins; 1991.
10. Kulkarni G. Textbook of Orthopedics and Trauma. 3rd ed., Vol. 4. New Delhi: Jaypee Brothers, Medical Publishers Pvt. Limited; 2016.
11. O’Brien JR. The Resident’s Guide to Spine Surgery. Germany: Springer Nature; 2019.
12. Manjila SV. Lumbar Interbody Fusions E-Book. Netherlands: Elsevier Health Sciences; 2018.
13. Hu W, Tang J, Wu X, Zhang L, Ke B. Minimally invasive versus open transforaminal lumbar fusion: A systematic review of complications. Int Orthop 2016;40:1883-90.
14. Skovrlj B. Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review. WJO 2015;6:996.
15. Garfin SR, Eismont FJ, Bell GR. Rothman-simeone and Herkowitz’s the Spine. 7th ed. Netherlands: Elsevier; 2018.
16. Benzel EC. Benzel’s Spine Surgery. 4th ed. Netherlands: Elsevier; 1999.
17. Miller LE, Bhattacharyya S, Pracyk J. Minimally invasive versus open transforaminal lumbar interbody fusion for single-level degenerative disease: A systematic review and meta-analysis of randomized controlled trials. World Neurosurg 2020;133:358-365.e4.


How to Cite this article: Mohan NS, Mundewadi VV, Chandrashekar HS | Prospective Comparative Study of Clinical and Radiological Outcome of Open versus Minimal Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 08-13.

 


                                          (Abstract    Full Text HTML)      (Download PDF)


What Exactly is Avascular Necrosis in Nonunion Scaphoid?

Vol. 9 | Issue 1 | January-February 2021 | Page: 02-07 | Anil K. Bhat, Mithun Pai. G, Ashwath M. Acharya, Sourab Shetty. S


Authors: Anil K. Bhat [1], Mithun Pai. G [1], Ashwath M. Acharya [1], Sourab Shetty. S [1]

[1] Department of Orthopaedics, Unit of Hand and Microsurgery, Kasturba Medical College, Manipal Academy of
Higher education, Manipal, Karnataka, India.

Address of Correspondence
Dr. Mithun Pai. G,
Senior Resident, Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of
Higher Education Karnataka, India.
E-mail: mithun.paig@manipal.edu

 


Abstract


Avascular necrosis or osteonecrosis is said to be higher when the fracture involves proximal one-third of the scaphoid with an incidence of 13 % to 27%1. The reason for this is the tenuous1 blood supply of the scaphoid, primarily from the branch of the radial artery entering mainly from the distal and dorsal surface of the bone. The proximal pole, therefore, is dependent entirely on this intraosseous blood flow. This retrograde, axial and unidirectional pattern of blood supply can result in a protracted healing process after a fracture which eventually leads to osteonecrosis, collapse and arthritis leading to disability.

 


References


1. Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg 1980; 5:508 –513
2. Herbert TJ, ed. The fractured scaphoid. St. Louis: Quality Medical Publishing, 1990:13–25
3. Fondi C, Franchi A (2007) Definition of bone necrosis by the
pathologist. Clin Cases Miner Bone Metab 4(1):21–26
4. Sakuma M, Nakamura R, Imaeda T. Analysis of proximal fragment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging. J Hand Surg 1995;20B:201–205
5. Smith ML, Bain GI, Chabrel N, Turner P, Carter C, Field J. Using computed tomography to assist with the diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am. 2009 Jul-Aug;34(6):1037-43.
6. Trumble TE, Irving J. Histologic and magnetic resonance imaging correlations in Kienböck’s disease. J Hand Surg Am 1990; 15:879–884
7. Trumble TE. Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg Am. 1990, 15: 557–64.
8. Perlik PC, Guilford WB. Magnetic resonance imaging to assess the vascularity of scaphoid nonunions. J Hand Surg Am 1991; 16:479–484
9. Schmitt R, Christopoulos G, Wagner M et al. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI? Eur J Radiol. 2011, 77:222–7
10. Cerezal L, Abascal F, Canga A, García-Valtuille R, Bustamante M, del Piñal F. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR 2000; 174:141–149
11. Anderson SE, Steinbach LS, Tschering-Vogel D, Martin M, Nagy L. MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting. Skeletal Radiol 2005; 34:314–320
12. Fox MG, Gaskin CM, Chhabra AB, Anderson MW. Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol. 2010, 195: W281–6.
13. Fox MG, Wang DT, Chhabra AB. Accuracy of enhanced and unenhanced MRI in diagnosing scaphoid proximal pole avascular necrosis and predicting surgical outcome. Skeletal Radiol. 2015, 44: 1671–8.
14. Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CWA. Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoid viability in patients with scaphoid nonunion? Radiology. 2011, 260: 808–16.
15. Urban MA, Green DP, Anfdemorte TB. The patchy configuration of scaphoid avascular necrosis. J Hand Surg Am 1993;18A:669–67
16. Gu¨nal I, Ozc¸elik A, Go¨ktu¨rk E, Ada S, Demirtas¸ M. Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion. Arch Orthop Trauma Surg. 1999, 119: 285–7.
17. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am 1985;10A:597–605
18. Boyer MI, von Schroeder HP, Axelrod TS. Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg Br. 1998, 23: 686–90
19. Straw RG, Davis TR, Dias JJ. Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery. J Hand Surg Br.2002;27(5):413
20. Tambe AD, Cutler L, Stilwell J, Murali SR, Trail IA, Stanley JK. Scaphoid non-union: the role of vascularized grafting in recalcitrant non-union of the scaphoid. J Hand Surg Br. 2006, 31: 185–90
21. Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW; Scaphoid Nonunion Consortium. The success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol. 2018 Jan;43(1):32-40.
22. Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am. 2015, 40: 1797–805
23. Kim J, Park JW, Chung J, Jeong Bae K, Gong HS, Baek GH. Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis. J Hand Surg Eur Vol. 2018 Jan;43(1):24-31. doi: 10.1177/1753193417730657. Epub 2017 Sep 11. PMID: 28893145.
24. Schmitt R, Heinze A, Fellner F, Obletter N, Struhn R, Bautz W. Imaging and staging of avascular osteonecrosis at the wrist and hand. Eur J Radiol 1997; 25:92–103
25. Morgan WJ, Breen TF, Coumas JM, Schulz LA. Role of magnetic resonance imaging in assessing factors affecting healing in scaphoid nonunions. Clin Orthop Relat Res 1997; 336:240–246

 


How to Cite this article: Bhat AK, Pai MG, Acharya AM, Shetty SS What | Exactly is Avascular Necrosis in Nonunion Scaphoid? | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 02-07.

 


                                          (Abstract    Full Text HTML)      (Download PDF)


From The Editor’s Desk

Vol. 9 | Issue 1 | January-February 2021 | Page: 01 | Anil K Bhat


Authors: Anil K Bhat [1]

[1] Department of Orthopaedics, KMC, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence

Dr. Anil K Bhat,
KMC, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: jkoa.editor@gmai.com, anilkbhat@yahoo.com


Dear All,

“When things do not go your way, remember that every challenge, every adversity contains within it the seeds of opportunity and growth.”  Roy T. Bennett

Nothing else can be better evidenced by the above statement than the current situation we are in. The pandemic made us realise the daunting challenges in public health, tribulation in maintaining the normal rhythm of life and immense opportunities to grow and rediscover our potential and strength.

For the orthopaedic surgeon, in particular, assuming the role of front line warriors along with other health care teams, adapting novel ways of performing surgeries in these trying times, embracing online learning and teaching and now, finally planning offline academic events, life is surely coming towards a full circle.

The catastrophe of the pandemic showed surgeons how innovative methods of telemedicine, webinars, virtual conferences and meetings can still keep us connected and cause no dent in our academic pursuits. Yes, there is the dark side of this pandemic which resulted in many of our colleagues losing lives, livelihood and going through one of the turbulent periods of our lives. We bow to their sacrifices and stand in support of their dear ones.

The publishing team has continued to work to not disappoint the authors who have kept faith in us and hence, this issue is being published in its usual schedule. I thank the entire team for this, along with our esteemed reviewers for the journal, KOA members and the office bearers for their constant support.

Best wishes for the year ahead

 

Dr. Anil K. Bhat

Chief editor

Associate Dean, Professor, Unit of Hand and Microsurgery,

Department of Orthopaedics, Kasturba Medical College, Manipal,

Manipal Academy of Higher education, Manipal


How to Cite this article: Bhat AK | From Editor’s Desk | Journal of Karnataka Orthopaedic Association| January-February 2021; 9(1): 01.

                                          (Abstract    Full Text HTML)      (Download PDF)