Rigid transpedicular fusion surgery in the treatment of degenerative lumbar stenosis

Grin A.A.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0003-3515-8329

Nikitin A.S.

Yevdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0002-1755-1752

Kalandari A.A.

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Asratyan S.A.

Buyanov City Clinical Hospital

Yundin S.V.

Evdokimov Moscow State University of Medicine and Dentistry

Yusupov S-E.R.

Evdokimov Moscow State University of Medicine and Dentistry

Rigid transpedicular fusion surgery in the treatment of degenerative lumbar stenosis

Authors:

Grin A.A., Nikitin A.S., Kalandari A.A., Asratyan S.A., Yundin S.V., Yusupov S-E.R.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2020;84(5): 41‑49

DOI: 10.17116/neiro20208405141

Downloaded: 129

To cite this article:

Grin AA, Nikitin AS, Kalandari AA, Asratyan SA, Yundin SV, Yusupov S-ER. Rigid transpedicular fusion surgery in the treatment of degenerative lumbar stenosis. Burdenko's Journal of Neurosurgery. 2020;84(5):41‑49. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20208405141

Подписка 2025-2 (Burdenko's Journal of Neurosurgery)

Close metadata

OBJECTIVE

To compare an effectiveness of different methods of rigid transpedicular fixation and decompression in patients with degenerative lumbar stenosis.

MATERIAL AND METHODS

A prospective study included 160 patients with degenerative lumbar spine stenosis. In the first group (n=37), patients underwent laminectomy and transpedicular fixation, in the second group (n=60) — laminectomy, transpedicular fixation and implantation of interbody fusion cage. In the third group (n=30), interlaminar decompression and transpedicular fixation were carried oud, in the fourth group (n=33) — interlaminar decompression, transpedicular fixation and implantation of interbody fusion cage. Surgeries were performed in three clinics in Moscow. Outcomes were assessed using a visual analogue scale (VAS) and Oswestry questionnaire in 1 and 2 years after surgery. Between-group comparison of the outcomes was performed. In patients with unfavorable outcome, we analyzed the cause of unsatisfactory result and risk factors.

RESULTS

Satisfactory result was noted in 103 patients (64%) in 2 years after surgery. Outcomes were comparable in all groups. More significant regression of back pain was noted in group II (laminectomy, transpedicular fixation, interbody cage) compared to other groups. Preoperative risk factors of adverse outcome were resting leg pain VAS score > 4 and age over 71 years. Incidence of pseudoarthrosis and back pain was higher among patients without interbody cage. Incidence of adjacent level lesion was higher among patients with interbody cages.

CONCLUSION

Decompression type and implantation of interbody cage do not significantly change postoperative outcomes in most patients with degenerative lumbar stenosis undergoing transpedicular fixation. However, interbody cage implantation during transpedicular fixation is advisable in patients with severe back pain (VAS score > 5-6).

Keywords:

lumbar spine stenosis

transpedicular fixation

Authors:

Grin A.A.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0003-3515-8329

Nikitin A.S.

Yevdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0002-1755-1752

Kalandari A.A.

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Asratyan S.A.

Buyanov City Clinical Hospital

Yundin S.V.

Evdokimov Moscow State University of Medicine and Dentistry

Yusupov S-E.R.

Evdokimov Moscow State University of Medicine and Dentistry

Received:

31.01.2020

Accepted:

03.07.2020

List of references:

Grin AA, Nikitin AS, Kalandari AA, Asratyan SA, Yusupov SR. Interlaminar decompression for patients with degenerative lumbar stenosis. Literature review and results of a prospective study. Russian Journal of Neurosurgery. 2019;21(4):57-66. (In Russ.) https://doi.org/10.17650/1683-3295-2019-21-4-57-66
Nikitin AS, Grin AA. Combination of degenerative lumbar spinal stenosis and spinal deformity. Literature review. Russian Journal of Neurosurgery. 2018;20(3):91-103. (In Russ.) https://doi.org/10.17650/1683-3295-2018-20-3-91-103
Nikitin AS, Grin AA. Diagnostics of instability at patients with degenerative disease of lumbar and sacral spine. Russian Journal of Neurosurgery. 2017;3:102-111. (In Russ.)
Kabins M, Weinstein J. The history of vertebral screw and pedicle screw fixa-tion. Iowa Orthopaedic Journal.1991;11:127-136.
Sterba W, Kim D, Fyhrie D, Yeni Y, Vaidya R. Biomechanical Analysis of Differing Pedicle Screw Insertion. Clinical Biomechanics (Bristol, Avon). 2007;22(4):385-391. https://doi.org/10.1016/j.clinbiomech.2006.11.007
Wu S, Edwards W, Yuan H. Stiffness between different directions of transpedicular screws and vertebra. Clinical Biomechanics (Bristol, Avon). 1998;13(1):l-8. https://doi.org/10.1016/S0268-0033(97)00069-7
Krag M, Beynnon B, Pope M, Decoster T. Depth of insertion of transpedicular screws into the human vertebrae: Effect upon screwvertebra interface strength. Journal of Spinal Disorders. 1988;1(4):287-294. https://doi.org/10.1097/00002517-198800140-00002
Gelalis I, Paschos N, Pakos E, Politis A, Arnaoutoglou C, Karageorgos A, Ploumis A, Xenakis T. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. European Spine Journal. 2012;21(2):247-255. https://doi.org/10.1007/s00586-011-2011-3
Gao S, Lv Z, Fang H. Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. European Spine Journal. 2018;27(4):921-930. https://doi.org/10.1007/s00586-017-5333-y
Konovalov NA, Shevelev IN, Kornienko VN, Nazarenko AG, Asyutin DS, Isaev KA, Zelenkov PV. Robotic assistance in spine surgery. Travmatologiya i ortopediya Rossii. 2010;2(56):62-63. (In Russ.) https://doi.org/10.21823/2311-2905-2010-0-2-62-63
Levin J, Tanenbaum J, Steinmetz M, Mroz T, Overley S. Posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis: a systematic review and meta-analysis. Spine Journal. 2018;18(6):1088-1098. https://doi.org/10.1016/j.spinee.2018.01.028
Kunder S, Kuijk S, Rijkers K, Caelers I, Hemert W, Bie R, Santbrink H. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. The Spine Journal. 2017;17(11):1712-1721. https://doi.org/10.1016/j.spinee.2017.06.018
Keorochana G, Pairuchvej S, Trathitephun W, Arirachakaran A, Predeeprompan P, Kongtharvonskul J. Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: systematic review and meta-analysis. World Neurosurgery. 2017;102:340-349. https://doi.org/10.1016/j.wneu.2017.03.010
Krutko AV. Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis. Zhurnal voprosy neirokhirurgii imeni N.N. Burdenko. 2012;76(2):33-41. (In Russ.)
Oda I, Abumi K, Yu B, Sudo H, Minami A. Types of spinal instability that require interbody support in posterior lumbar reconstruction: an in vitro biomechanical investigation. Spine (Phila Pa 1976). 2003;28(14):1573-1580.
Farrokhi M, Yadollahikhales G, Gholami M, Mousavi S, Mesbahi A, Asadi-Pooya A. Clinical outcomes of posterolateral fusion versus posterior lumbar interbody fusion in patients with lumbar spinal stenosis and degenerative instability. Pain Physician. 2018;21(4):383-406.

Close metadata