脊椎ジャーナル

Transforaminal Lumbar Interbody Fusion (TLIF) Using Pedicle Screws with Mobility

Abstract

Hideki Ohta, Yoshiyuki Matsumoto, Yoshikazu Nakayama, Tsubasa Sakai, Youhei Iguchi, Masato Tatsumi, Hirotaka Kida and Yoshiharu Takemitsu

We believed that the delivery of a moderate compression force to bone grafts in transforaminal lumbar interbody fusion (TLIF) was better for bony union and performed the TLIF using a pedicle screw with mobility. Using the Segmental Spinal Correction System for TLIF, we investigated 13 patients with a minimum postoperative follow-up of 1 year. A good bony union was observed and clinical results included an improvement rate of 76.8%. Recent spinal instruments are made from more rigid and break-resistant materials. Bony union is less likely to be achieved in TLIF unless segmental subsidence is tolerated to some extent. The use of pedicle screws with mobility may enhance bony union.
Background: TLIF using a rigid pedicle screw has become the gold standard in spinal fusion. However, do stronger instruments have advantages for bony union? Bone grafts in TLIF once undergo necrosis and the volume decreases over time. If the disc height does not decrease accordingly, it will create some space between the grafted bone and both upper and lower vertebral bodies, which is disadvantageous for bony union. Thus, we considered that a pedicle screw with mobility would provide moderate compression force to the bone grafts in TLIF and would be better for bony union. The Segmental Spinal Correction System (SSCS) was used for TLIF in this study.
Results: We investigated the clinical results of this method in 13 patients (6 male and 7 female, 56 to 79 y/o) with a minimum 1-year follow-up. The mean JOA score improved from 13.5 pre-OP to 25.4 post-OP. The mean improvement rate was 76.8%. Bony union was observed for all patients.
Conclusion: TLIF using a pedicle screw with mobility provides moderate compression force to the bone grafts in TLIF and bony union may be enhanced. This could be a new method in spinal fusion surgery.

We believed that the delivery of a moderate compression force to bone grafts in transforaminal lumbar interbody fusion (TLIF) was better for bony union and performed the TLIF using a pedicle screw with mobility. Using the Segmental Spinal Correction System for TLIF, we investigated 13 patients with a minimum postoperative follow-up of 1 year. A good bony union was observed and clinical results included an improvement rate of 76.8%. Recent spinal instruments are made from more rigid and break-resistant materials. Bony union is less likely to be achieved in TLIF unless segmental subsidence is tolerated to some extent. The use of pedicle screws with mobility may enhance bony union.
Background: TLIF using a rigid pedicle screw has become the gold standard in spinal fusion. However, do stronger instruments have advantages for bony union? Bone grafts in TLIF once undergo necrosis and the volume decreases over time. If the disc height does not decrease accordingly, it will create some space between the grafted bone and both upper and lower vertebral bodies, which is disadvantageous for bony union. Thus, we considered that a pedicle screw with mobility would provide moderate compression force to the bone grafts in TLIF and would be better for bony union. The Segmental Spinal Correction System (SSCS) was used for TLIF in this study.
Results: We investigated the clinical results of this method in 13 patients (6 male and 7 female, 56 to 79 y/o) with a minimum 1-year follow-up. The mean JOA score improved from 13.5 pre-OP to 25.4 post-OP. The mean improvement rate was 76.8%. Bony union was observed for all patients.
Conclusion: TLIF using a pedicle screw with mobility provides moderate compression force to the bone grafts in TLIF and bony union may be enhanced. This could be a new method in spinal fusion surgery.