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2014년 5월 28일 수요일

Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Brief review

전방경유 요추 유합술과 추간공경유 요추 유합술을 비교하여 술 후의 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목을 측정하여 연구한 논문 입니다.

전방경유 요추 유합술이 추간공경유 요추 유합술에 비해 위에서 언급한 추간공의 높이와 디스크의 각도, 요추전만각 및 시상면 정렬 등의 항목에서 우수한 결과를 보였습니다.

이 논문은 방사선학적 측정값이 주를 이루므로 설명보다는 표로 보는게 쉬워서 아래와 같이 첨부했습니다.



*Title: Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

*Authors: PATRICK C. HSIEH, TYLER R. KOSKI, BRIAN A. O’SHAUGHNESSY, PATRICK SUGRUE, SEAN SALEHI, STEPHEN ONDRA, JOHN C. LIU




Backgroud of data
-A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance.

-There has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters.


OBJECT
The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.


METHODS
Study design : retrospective study(medical records and radiographs review)
Subjects: 32 patients (ALIF)+ 25 patients (TLIF) (2000~2004)
Data measurement
-Clinical data: VAS score (pre&post:6,12,24mon)
-radiographic data: foraminal height, local disc angle, and lumbar lordosis (pre&post)

Statistical analyses: included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.


RESULTS
-ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.
increasing rate or degree in radiographic data
-foraminal height: 18.5%(ALIF) vs 0.4%(TLIF)
-local disc angle: 8.3 degrees(ALIF) vs 0.1 degree(TLIF)
-lumbar lordosis: 6.2 degrees(ALIF)  vs 2.1 degrees(TLIF)












































































CONCLUSIONS
-The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.

-The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.