2 articles
Dual x-ray absorptiometry (DEXA) scan has been the gold standard for assessing bone mineral density prior to spinal instrumentation surgery. DEXA scans, on the other hand, can produce falsely elevated measurements in patients with severe degenerative changes, compression fractures, and aortic calcification, which can lead to incorrect patient selection and failed interbody fusion.
Detailed anamnesis of disease development, thorough clinical examination, patient-reported outcome measures (pain VAS, ODI, SF-12), preoperative and postoperative bone-window CT of the spine (interbody fusion status assessment), vertebral bone mineral density assessment by DEXA scan, vertebral bone density measurement in Hounsfield units by computer tomography, and the review of published literature were analysed.
A 67-year-old woman was diagnosed with L4-L5 degenerative spondylolisthesis. DEXA scan revealed normal bone mineral density in the lumbar vertebrae. The patient underwent midline lumbar interbody fusion (MIDLIF). The postoperative course was complicated by the occurrence of clinical and radiographic signs of pseudarthrosis. She refused revision surgery and was lost to follow-up. Three years postoperatively, she presented in good physical condition, with significant improvement in pain and functional disability. A CT scan showed delayed successful interbody fusion with complete resolution of radiolucency around implants.
This case report summarizes some of the possible errors in diagnosis and surgical treatment in patients with degenerative pathology associated with severe vertebral osteoporosis.
Currently, the standard treatment of degenerative spondylolisthesis involves pedicle screw fixation to enhance the success of intervertebral fusion. The traditional pedicle screw techniques require extensive lateral muscle dissection, resulting in significantly increased surgical-related morbidity. To address some of these shortcomings, the Midline Lumbar Interbody Fusion (MIDLIF®) technique has recently been developed. It involves the combination of the cortical bone trajectory screw fixation of the spine with intervertebral cage placement to achieve a solid interbody fusion. So far, the clinical efficacy of the MIDLIF technique in the treatment of low-grade degenerative spondylolisthesis is still unknown. All existing publications are studies with a low level of relevance or scientific evidence.
A prospective randomized controlled trial was conducted between 2017 and 2022. The study analyzed the clinical and radiological effectiveness of the MIDLIF arthrodesis technique compared to the traditional lumbar interbody fusion techniques, used exclusively in the treatment of degenerative lumbar spondylolisthesis.
The study enrolled 112 eligible patients with degenerative low-grade spondylolisthesis, randomly assigned into two groups. At 1 year post-operatively, MIDLIF provided a significantly better improvement in postoperative relief of low back pain and radiating pain, as well as a significantly better functional recovery. Additionally, MIDLIF resulted in lower surgical morbidity compared to traditional fusion techniques.
The success rate of MIDLIF arthrodesis is similar to that associated with traditional fusion techniques. At the same time, MIDLIF offers all the specific benefits of a minimally invasive approach, such as less postoperative pain, faster functional recovery, less bleeding, and fewer blood transfusions. Thus, MIDLIF might be a good alternative to the traditional intervertebral fusion techniques in the treatment of degenerative low-grade spondylolisthesis.