Our Summary

This research paper talks about a study conducted to understand the effectiveness of a less invasive procedure for treating a condition known as Adjacent Segment Disease (ASD), which is a common complication after lumbar fusion surgery. The treatment being evaluated is called Lumbar Lateral Interbody Fusion (LLIF), which uses a different approach compared to traditional posterior spinal fusion surgery.

The study was conducted on cadavers (dead bodies used for scientific research), which were divided into three groups, each representing different levels of spinal fusion. The research team then simulated the ASD condition and performed various versions of the LLIF treatment, including using a standing-alone technique, combining it with a plate or a single screw rod (SSR), and using traditional posterior extension of spinal fusion.

The movement range of the spine was measured before and after these treatments under different conditions. The results showed that LLIF treatment effectively reduced the range of movement in all cases. When LLIF was combined with a plate or SSR, it provided even better stability. However, the most effective method was the traditional expansion of posterior instrumentation, which provided the most substantial stability in all conditions.

In simpler terms, the study suggests that LLIF might be a promising alternative treatment for ASD. Still, the traditional expansion of posterior instrumentation remains the most effective method in terms of stability.

FAQs

  1. What is the condition called Adjacent Segment Disease (ASD)?
  2. What is Lumbar Lateral Interbody Fusion (LLIF) and how does it differ from traditional posterior spinal fusion surgery?
  3. Based on the study, what method provides the most substantial stability in treating ASD?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to discuss with their healthcare provider the different treatment options available, including less invasive procedures like Lumbar Lateral Interbody Fusion (LLIF), and to consider the potential benefits and risks of each option before making a decision. It is essential for patients to have an open and honest conversation with their doctor to ensure they receive the most appropriate treatment for their specific condition.

Suitable For

Patients who are typically recommended lumbar fusion surgery include those with severe back pain and/or leg pain caused by conditions such as degenerative disc disease, spinal stenosis, spondylolisthesis, or spinal fractures. These patients may have tried non-surgical treatments such as physical therapy, medications, and injections without success. Additionally, patients with instability in the spine or those who have not responded well to previous spinal surgeries may also be candidates for lumbar fusion. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion is the best treatment option for their specific condition.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain, leg pain, and other symptoms due to conditions such as degenerative disc disease, spinal stenosis, or herniated discs.
  2. Patient undergoes various non-surgical treatments such as physical therapy, medications, and injections to manage symptoms.
  3. If non-surgical treatments fail to provide relief, patient and their healthcare provider decide on lumbar fusion surgery as a treatment option.

After lumbar fusion:

  1. Patient undergoes pre-operative preparations and evaluations to ensure they are fit for surgery.
  2. Lumbar fusion surgery is performed, where the damaged disc is removed, and the vertebrae are fused together using bone grafts, screws, and rods.
  3. Patient goes through post-operative recovery, which includes pain management, physical therapy, and restrictions on activities to allow the spine to heal.
  4. Patient gradually resumes normal activities and follows up with their healthcare provider for monitoring and management of any complications or ongoing symptoms.
  5. Patient experiences improvement in back and leg pain over time as the spine stabilizes and heals after surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion, based on this research paper, may include:

  1. What is the likelihood of developing Adjacent Segment Disease (ASD) after lumbar fusion surgery?
  2. Are there less invasive treatment options like Lumbar Lateral Interbody Fusion (LLIF) available for treating ASD?
  3. How does LLIF compare to traditional posterior spinal fusion surgery in terms of effectiveness and stability?
  4. What are the potential risks and benefits of different versions of the LLIF treatment, such as using a standing-alone technique, combining it with a plate or single screw rod (SSR), or traditional posterior extension of spinal fusion?
  5. How does the movement range of the spine change after these treatments, and how does it impact overall stability?
  6. What factors should be considered when deciding on the most appropriate treatment approach for ASD after lumbar fusion surgery?
  7. Are there any long-term studies or clinical trials supporting the effectiveness of LLIF for treating ASD?
  8. What is the success rate of traditional expansion of posterior instrumentation compared to LLIF in preventing or managing ASD?
  9. How soon after lumbar fusion surgery can a patient undergo LLIF or other alternative treatments for ASD?
  10. What post-operative care and rehabilitation measures are recommended for patients undergoing LLIF or traditional posterior instrumentation for ASD after lumbar fusion surgery?

Reference

Authors: Shasti M, Koenig SJ, Nash AB, Bahrami S, Jauregui JJ, O’Hara NN, Jazini E, Gelb DE, Ludwig SC. Journal: Spine J. 2019 Mar;19(3):545-551. doi: 10.1016/j.spinee.2018.09.002. Epub 2018 Sep 7. PMID: 30201269