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circumferential_fusion

Circumferential fusion

Circumferential fusion is basically a bi-directional (anterior and posterior) approach, with circumferential arthrodesis. This technique is best used to provide solid internal stability together with bony fusion 1) 2) 3).

Findings suggest that anterior lumbar interbody fusion with percutaneous pedicle screws can achieve better clinical outcomes compared to TLIF for the treatment of isthmic spondylolisthesis (IS).

Tye et al. believe the superior radiographic outcomes achieved through ALIFPS, namely a greater restoration of segmental lordosis and disc height, may have contributed to the improved clinical outcomes presented in the current study 4).

Indications

Circumferential fusion provided significantly better long-term clinical, radiographic, and Scoliosis Research Society (SRS) total score than posterolateral or anterior fusion for high-grade isthmic spondylolisthesis 5).

Iatrogenic, high-grade L5-S1 spondylolisthesis can be successfully treated with reduction using circumferential fusion of the lumbosacral junction 6).


Pseudoarthrosis in ankylosing spondylitis (Andersson lesion, AL) can cause progressive kyphosis and neurological deficit. Management involves early recognition and surgical stabilisation in patients with instability. However, the need and safety of anterior reconstruction of the vertebral body defect remains unclear.

Twenty consecutive patients with AL whom presented with instability back pain and or neurological deficit were managed by single stage posterior approach with long segment pedicle screw fixation and anterior vertebral reconstruction. Radiological evaluation included- the regional kyphotic angle, measurement of anterior defect in computed tomography (CT) scan and the spinal cord status in magnetic resonance imaging. Radiological outcomes were assessed for fusion and kyphosis correction. Functional outcomes were assessed with visual analogue scale (VAS), ankylosing spondylitis quality of life (ASQoL) and Oswestry disability index (ODI).

The mean age of the patients was 50.1 years (male, 18; female, 2). The levels affected include thoracolumbar (n=12), lower thoracic (n=5) and lumbar (n=3) regions. The mean level of fixation was 6.2±2.4 vertebrae. The mean anterior column defect was 1.6±0.6 cm. The mean surgical duration, blood loss and hospital stay were 112 minutes, 452 mL and 6.2 days, respectively. The mean followup was 2.1 years. At final follow up, VAS for back pain improved from 8.2 to 2.4 while ODI improved from 62.7 to 18.5 (p <0.05) and ASQoL improved from 14.3±2.08 to 7.90±1.48 (p <0.05). All patients had achieved radiological union at a mean 7.2±4.6 months. The mean regional kyphotic angle was 27° preoperatively, 16.7° postoperatively and 18.1° at the final follow-up.

Posterior stabilisation and anterior reconstruction with cage through an all-posterior approach is safe and can achieve good results in Andersson lesions 7).

1)
Cooper PR, Operative management of cervical spine injuries. Clin Neurosurg 1988; 34: 650-74.
2)
Capen DA, Garland DE, Waters RL. Surgical stabilization of the cervical spine: a comparative analysis of anterior and posterior spine fusions. Clin Orthop 1985; 196: 229-37.
3)
Mc Afee PC, Bohlman HH: One stage anterior cervical decompression and posterior stabilization with circumferential arthrodesis: A study of twenty-four patients who had a traumatic or neoplastic lesion. J Bone Joint Surg (Am) 1989; 71 A: 78-88
4)
Tye EY, Tanenbaum JE, Alonso AS, Xiao R, Steinmetz MP, Mroz TE, Savage JW. Circumferential Fusion: A Comparative Analysis Between Anterior Lumbar Interbody Fusion with Posterior Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for L5-S1 Isthmic Spondylolisthesis. Spine J. 2017 Aug 15. pii: S1529-9430(17)30901-4. doi: 10.1016/j.spinee.2017.08.227. [Epub ahead of print] PubMed PMID: 28821444.
5)
Helenius I, Lamberg T, Osterman K, Schlenzka D, Yrjönen T, Tervahartiala P, Seitsalo S, Poussa M, Remes V. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society questionnaire. Spine (Phila Pa 1976). 2006 Jan 15;31(2):190-6. PubMed PMID: 16418639.
6)
Theologis AA, Jain D, Ames CP, Pekmezci M. Circumferential fusion for degenerative lumbar spondylolisthesis complicated by distal junctional grade 4 spondylolisthesis in the sub-acute post-operative setting. Eur Spine J. 2017 Feb 15. doi: 10.1007/s00586-017-4976-z. [Epub ahead of print] PubMed PMID: 28204925.
7)
Rajoli SR, Kanna RM, Aiyer SN, Shetty AP, Rajasekaran S. Circumferential Fusion through All-Posterior Approach in Andersson Lesion. Asian Spine J. 2017 Jun;11(3):444-453. doi: 10.4184/asj.2017.11.3.444. Epub 2017 Jun 15. PubMed PMID: 28670413; PubMed Central PMCID: PMC5481600.
circumferential_fusion.txt · Last modified: 2018/08/01 15:37 by administrador