The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Praveen V Mummaneni - One of the best experts on this subject based on the ideXlab platform.
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approach selection multiple anterior Lumbar Interbody Fusion to recreate Lumbar lordosis versus pedicle subtraction osteotomy when why how
Neurosurgery Clinics of North America, 2018Co-Authors: Andrew Chan, Praveen V Mummaneni, Christopher I ShaffreyAbstract:Restoration of physiologic Lumbar lordosis is a fundamental principle of spinal deformity surgery. Techniques using multilevel anterior Lumbar Interbody Fusion or pedicle subtraction osteotomy (PSO) are described. Multilevel anterior Lumbar Interbody Fusion provides a gradual multilevel correction and avoids the morbidity associated with PSO but necessitates familiarity with the anterior approach or an approach surgeon. PSO provides a large angular correction at a single level, requires only one approach, and allows for simultaneous multiplanar correction and open posterior decompression. This article provides guidance on the appropriate use of each technique for restoration of Lumbar lordosis in patients with degenerative Lumbar deformity.
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stereotactic navigation for the prepsoas oblique lateral Lumbar Interbody Fusion technical note and case series
Neurosurgical Focus, 2017Co-Authors: Anthony M Digiorgio, Praveen V Mummaneni, Caleb S Edwards, Michael S Virk, Dean ChouAbstract:The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior Lumbar Interbody Fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral Lumbar Interbody Fusion in a series of 49 patients.
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clinical and radiographic comparison of mini open transforaminal Lumbar Interbody Fusion with open transforaminal Lumbar Interbody Fusion in 42 patients with long term follow up clinical article
Journal of Neurosurgery, 2008Co-Authors: Sanjay S Dhall, Michael Y Wang, Praveen V MummaneniAbstract:Object As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal Lumbar Interbody Fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF. Methods Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), Fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals. Results No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 19...
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the mini open transforaminal Lumbar Interbody Fusion
Neurosurgery, 2005Co-Authors: Praveen V Mummaneni, Gerald E RodtsAbstract:The mini-open approach for transforaminal Lumbar Interbody Fusion is described in detail. Operating room setup and surgical positioning are demonstrated. Our methods of retractor placement and techniques for optimal surgical exposure are discussed. The surgical technique used for decompression and Fusion is presented in detail. The surgical pearls and pitfalls of the mini-open TLIF are described and illustrated.
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Analysis of operative complications in a series of 471 anterior Lumbar Interbody Fusion procedures
Spine, 2005Co-Authors: Rick C. Sasso, Natalie M. Best, Thomas M. Reilly, Praveen V Mummaneni, Sajjad M. HussainAbstract:STUDY DESIGN: This retrospective review compares the intraoperative and perioperative complications associated with the placement of threaded devices and nonthreaded devices used in anterior Lumbar Interbody Fusions. OBJECTIVE: Anterior Lumbar Interbody Fusion is a common procedure performed with either a nonthreaded device, such as a femoral ring, or a threaded device, such as with a cage or a bone dowel. SUMMARY OF BACKGROUND DATA: Many studies have been done detailing the Fusion rates and biomechanical properties of both devices. However, few studies have been performed evaluating acute complications between the two device types. METHODS: A retrospective chart review was performed of 471 consecutive patients who underwent anterior Lumbar Interbody Fusion: 243 with a nonthreaded Interbody device and 228 with a threaded Interbody device. Operative notes, anesthesia reports, discharge summaries, and follow-up notes were reviewed from 1992 to June 2002. The patients' demographics, diagnosis, number of levels fused, type of device used, length of hospital stay, and acute complications, either intraoperative or perioperative, were collected and analyzed. RESULTS: Approximately 4.8% of patients with a threaded type Interbody device had an intraoperative complication whereas only 0.4% of patients with a nonthreaded type device had an intraoperative complication. There was a significant association between Interbody device type (threaded vs. nonthreaded) and occurrence of an intraoperative complication (P = 0.0024). CONCLUSIONS: Placement of threaded devices, such as cages or bone dowels, was associated with a higher acute complication rate than was the placement of nonthreaded devices during anterior Lumbar Interbody Fusion.
Alan T Villavicencio - One of the best experts on this subject based on the ideXlab platform.
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complications in patients undergoing combined transforaminal Lumbar Interbody Fusion and posterior instrumentation with deformity correction for degenerative scoliosis and spinal stenosis
Surgical Neurology International, 2012Co-Authors: Sigita Burneikiene, Lee E Nelson, Alexander Mason, Sharad Rajpal, Benjamin Serxner, Alan T VillavicencioAbstract:Background: Utilization of the transforaminal Lumbar Interbody Fusion (TLIF) approach for scoliosis offers the patients deformity correction and Interbody Fusion without the additional morbidity associated with more invasive reconstructive techniques. Published reports on complications associated with these surgical procedures are limited. The purpose of this study was to quantify the intra- and postoperative complications associated with the TLIF surgical approach in patients undergoing surgery for spinal stenosis and degenerative scoliosis correction.
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minimally invasive versus open transforaminal Lumbar Interbody Fusion
Surgical Neurology International, 2010Co-Authors: Alan T Villavicencio, Sigita Burneikiene, Cassandra Roeca, Lee E Nelson, Alexander MasonAbstract:Background: Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal Lumbar Interbody Fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal Lumbar Interbody Fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches. Materials and Methods: Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous Lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab’s criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months. Results: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in the open TLIF patient group (P = 0.3). MacNab’s criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower ( P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was 10.5% in the minimally invasive TLIF group compared to 1.6% in the open group (P = 0.02). Conclusions: Minimally invasive TLIF technique may provide equivalent long-term clinical outcomes compared to open TLIF approach in select population of patients. The potential benefit of minimized tissue disruption, reduced blood loss, and length of hospitalization must be weighted against the increased rate of neural injury-related complications associated with a learning curve.
Alexander Mason - One of the best experts on this subject based on the ideXlab platform.
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complications in patients undergoing combined transforaminal Lumbar Interbody Fusion and posterior instrumentation with deformity correction for degenerative scoliosis and spinal stenosis
Surgical Neurology International, 2012Co-Authors: Sigita Burneikiene, Lee E Nelson, Alexander Mason, Sharad Rajpal, Benjamin Serxner, Alan T VillavicencioAbstract:Background: Utilization of the transforaminal Lumbar Interbody Fusion (TLIF) approach for scoliosis offers the patients deformity correction and Interbody Fusion without the additional morbidity associated with more invasive reconstructive techniques. Published reports on complications associated with these surgical procedures are limited. The purpose of this study was to quantify the intra- and postoperative complications associated with the TLIF surgical approach in patients undergoing surgery for spinal stenosis and degenerative scoliosis correction.
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minimally invasive versus open transforaminal Lumbar Interbody Fusion
Surgical Neurology International, 2010Co-Authors: Alan T Villavicencio, Sigita Burneikiene, Cassandra Roeca, Lee E Nelson, Alexander MasonAbstract:Background: Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal Lumbar Interbody Fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal Lumbar Interbody Fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches. Materials and Methods: Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous Lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab’s criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months. Results: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in the open TLIF patient group (P = 0.3). MacNab’s criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower ( P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was 10.5% in the minimally invasive TLIF group compared to 1.6% in the open group (P = 0.02). Conclusions: Minimally invasive TLIF technique may provide equivalent long-term clinical outcomes compared to open TLIF approach in select population of patients. The potential benefit of minimized tissue disruption, reduced blood loss, and length of hospitalization must be weighted against the increased rate of neural injury-related complications associated with a learning curve.
Rick C. Sasso - One of the best experts on this subject based on the ideXlab platform.
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Analysis of operative complications in a series of 471 anterior Lumbar Interbody Fusion procedures
Spine, 2005Co-Authors: Rick C. Sasso, Natalie M. Best, Thomas M. Reilly, Praveen V Mummaneni, Sajjad M. HussainAbstract:STUDY DESIGN: This retrospective review compares the intraoperative and perioperative complications associated with the placement of threaded devices and nonthreaded devices used in anterior Lumbar Interbody Fusions. OBJECTIVE: Anterior Lumbar Interbody Fusion is a common procedure performed with either a nonthreaded device, such as a femoral ring, or a threaded device, such as with a cage or a bone dowel. SUMMARY OF BACKGROUND DATA: Many studies have been done detailing the Fusion rates and biomechanical properties of both devices. However, few studies have been performed evaluating acute complications between the two device types. METHODS: A retrospective chart review was performed of 471 consecutive patients who underwent anterior Lumbar Interbody Fusion: 243 with a nonthreaded Interbody device and 228 with a threaded Interbody device. Operative notes, anesthesia reports, discharge summaries, and follow-up notes were reviewed from 1992 to June 2002. The patients' demographics, diagnosis, number of levels fused, type of device used, length of hospital stay, and acute complications, either intraoperative or perioperative, were collected and analyzed. RESULTS: Approximately 4.8% of patients with a threaded type Interbody device had an intraoperative complication whereas only 0.4% of patients with a nonthreaded type device had an intraoperative complication. There was a significant association between Interbody device type (threaded vs. nonthreaded) and occurrence of an intraoperative complication (P = 0.0024). CONCLUSIONS: Placement of threaded devices, such as cages or bone dowels, was associated with a higher acute complication rate than was the placement of nonthreaded devices during anterior Lumbar Interbody Fusion.
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A prospective, randomized controlled clinical trial of anterior Lumbar Interbody Fusion using a titanium cylindrical threaded Fusion device.
Spine, 2004Co-Authors: Rick C. Sasso, Scott H. Kitchel, Edgar G. DawsonAbstract:STUDY DESIGN A prospective, randomized, controlled clinical trial comparing a cylindrical threaded titanium cage to a femoral ring allograft control for anterior Lumbar Interbody Fusion. OBJECTIVE To compare these two implants with regard to arthrodesis. Secondary outcome measures included pain relief, neurological status, and general health status. SUMMARY OF BACKGROUND DATA Anterior Lumbar Interbody Fusion is a well-accepted procedure using trapezoidal femoral ring allografts or cylindrical titanium cages. Clinical and biomechanical studies evaluating these two distinct constructs are numerous; however, no prospective, randomized study comparing them has been done. METHODS A multicenter trial of 140 patients: 78 were randomized to the cylindrical threaded titanium cage device treatment arm and 62 patients randomized into the control group. All had autogenous iliac crest bone graft packed into the device. All patients had a single-level stand-alone anterior Lumbar Interbody Fusion at either the L4-L5 or L5-S1 interspace for symptomatic degenerative disc disease. Radiographic Fusion data were collected as well as multiple types of outcome data, including pain/disability scores, neurologic status, and overall health. RESULTS At 12 months, 97% of the cylindrical threaded titanium cage device group and 40% of the control group demonstrated radiographic Fusion. At 24 months, 97% of the cylindrical threaded titanium cage group and 52% of the control group showed radiographic Fusion. These Fusion rate differences are statistically significant (P < 0.001). The Oswestry and neurologic scores were not significantly different between groups. DISCUSSION This is the first prospective, randomized, multicenter clinical trial that compares Fusion cage results to control data. CONCLUSION Cylindrical threaded titanium cages have a higher Fusion rate, comparable improvements in clinical outcome (Oswestry, Low Back Pain Questionnaire, SF-36), and fewer secondary supplemental fixation procedures compared to the femoral ring allograft control.
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Retrograde Ejaculation After Anterior Lumbar Interbody Fusion : Transperitoneal Versus Retroperitoneal Exposure
Spine, 2003Co-Authors: Rick C. Sasso, J. Kenneth Burkus, Jean Charles LehuecAbstract:STUDY DESIGN In this multicenter, prospective, 2-year study, 146 male patients underwent a single-level anterior Lumbar Interbody Fusion with a tapered threaded titanium Fusion device. All the patients were advised before surgery of the risk for retrograde ejaculation. After surgery, any case of retrograde ejaculation was recorded as an adverse event, and the patient was observed up for the remainder of the study. OBJECTIVE To determine the incidence of retrograde ejaculation in male patients treated for single-level degenerative Lumbar disc disease at L4-L5 or L5-S1 with a stand-alone anterior Interbody Fusion using tapered, threaded titanium Fusion cages. SUMMARY OF BACKGROUND DATA The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%. Various risk factors that increase the chance of retrograde ejaculation have been proposed. METHODS In this prospective study, 146 male patients underwent an open surgical exposure of the lumbosacral junction and a single-level Interbody Fusion at either L4-L5 or L5-S1. Assessment of a patient's clinical outcome was based on written questionnaires at 6 weeks and then 3, 6, 12, and 24 months after surgery. Patients were questioned about adverse events at each of these assessments, and any case of retrograde ejaculation was recorded and followed. RESULTS Retrograde ejaculation developed in 6 of the 146 men after open anterior Lumbar Interbody Fusion surgery. Two cases (1.7%; 2/116) involved patients who underwent a retroperitoneal surgical exposure. Four cases (13.3%; 4/30) involved patients who had a transperitoneal surgical exposure. This difference is statistically significant according to Fisher's exact test (P = 0.017). At 12 months after surgery, 2 patients had resolution of their symptoms: 1 in the retroperitoneal approach group and 1 in the transperitoneal group. At the final 2-year follow-up, no changes in symptoms were reported. One patient in the retroperitoneal approach group (0.86%) and three patients in the transperitoneal group (10%) reported permanent retrograde ejaculation (P = 0.027). CONCLUSIONS A transperitoneal approach to the Lumbar spine at L4-L5 and L5-S1 has a 10 times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach.
N R Boeree - One of the best experts on this subject based on the ideXlab platform.
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outcome of posterior Lumbar Interbody Fusion versus posterolateral Fusion for spondylolytic spondylolisthesis
Spine, 2002Co-Authors: Sanjeev Madan, N R BoereeAbstract:Study design This retrospective study analyzed the outcome of 44 patients who had decompression, pedicle screw-rod fixation, and Fusion for Grades 1 and 2 spondylolytic spondylolisthesis. Objective To evaluate the outcome of two methods for stabilization and Fusion: posterolateral Fusion and circumferential Fusion involving posterior Lumbar Interbody Fusion and posterolateral Fusion for low grades of isthmic spondylolisthesis. Summary of background data It has been suggested that stabilization with instrumented Fusion is somewhat unpredictable due to lack of anterior support. Does circumferential Fusion using posterior Lumbar Interbody Fusion circumvent all the problems, and is it better than posterolateral Fusion clinically? Methods A single surgeon treated 21 patients with instrumented posterolateral Fusion and 23 patients with instrumented circumferential Fusion, (i.e., posterior Lumbar Interbody Fusion, and posterolateral Fusion. These two groups were compared for clinical outcome, Fusion rate, and correction of slippage. Results The minimum follow-up period for the patients was 2.1 years. The clinical satisfactory outcome on the Oswestry index was 81% for posterolateral Fusion and 69% for posterior Lumbar Interbody Fusion. The subjective outcome was 86% and 65%, respectively, for the two groups (P > 0.05). However, a consideration of subjective scores showed that three patients (14.3%) in posterolateral Fusion group and eight patients (34.8%) in posterior Lumbar Interbody Fusion group had an unsatisfactory outcome (P = 0.0135), which was very significant. There were two nonunions in the posterolateral Fusion group and none in the posterior Lumbar Interbody Fusion group (P > 0.05). The correction of slippage and the loss of correction at the last follow-up assessment was better in the posterior Lumbar Interbody Fusion group, although this was not statistically significant (P > 0.05). Radicular symptoms and neurologic improvement were statistically similar between the two groups. Conclusions Posterolateral Fusion has a better clinical outcome in low grades of isthmic spondylolisthesis, although posterior Lumbar Interbody Fusion is more predictable in maintaining correction and achieving union. Careful patient selection is needed for each operation, and adjacent level disc degeneration may influence the procedure offered to the patient.
