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First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note

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An Erratum to this article was published on 17 February 2017

This article has been updated

Abstract

Purpose

First description of MIS-VLIF, a minimally invasive lumbar stabilization, to evaluate its safety and feasibility in patients suffering from weak bony conditions (lumbar spondylodiscitis and/or osteoporosis).

Methods

After informed consent, 12 patients suffering from lumbar spondylodiscitis underwent single level MIS-VLIF. Eight of them had a manifest osteoporosis, either. Pre- and postoperative clinical status was documented using numeric rating scale (NRS) for leg and back pain. In all cases, the optimal height for the cage was preoperatively determined using software-based range of motion and sagittal balance analysis. CT scans were obtained to evaluate correct placement of the construct and to verify fusion after 6 months.

Results

Since 2013, 12 patients with lumbar pyogenic spondylodiscitis underwent MIS-VLIF. Mean surgery time was 169 ± 28 min and average blood loss was less than 400 ml. Postoperative CT scans showed correct placement of the implants. Eleven patients showed considerable postoperative improvement in clinical scores. In one patient, we observed screw loosening. After documented bony fusion in the CT scan, the fixation system was removed in two cases to achieve lower material load.

Conclusions

The load-bearing trajectories (vectors) of MIS-VLIF are different from those of conventional coaxial pedicle screw implantation. The dorsally converging construct combines the heads of the dorsoventral pedicle screws with laminar pedicle screws following cortical bone structures within a small approach. In case of lumbar spondylodiscitis and/or osteoporosis, MIS-VLIF relies on cortical bony structures for all screw vectors and the construct does not depend on conventional coaxial pedicle screws in the presence of inflamed, weak, cancellous or osteoporotic bone. MIS-VLIF allows full 360° lumbar fusion including cage implantation via a small, unilateral dorsal midline approach.

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  • 17 February 2017

    An erratum to this article has been published.

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Author notes

    Authors and Affiliations

    1. Department of Neurosurgery, Carl Gustav Carus University Hospital, Technical University of Dresden, 01307, Dresden, Germany

      Bernhard Rieger, Hongzhen Jiang & Gabriele Schackert

    2. Spine Center DWG Level I, Carl Gustav Carus University Hospital, Technical University of Dresden, 01307, Dresden, Germany

      Bernhard Rieger, Hongzhen Jiang & Gabriele Schackert

    3. Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China

      Hongzhen Jiang & Huaiyu Tong

    4. Department of Stereotactic and Functional Neurosurgery, University of Cologne, 50937, Cologne, Germany

      Daniel Ruess

    5. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

      Clemens Reinshagen

    6. Institute of Neurophysiology, Medical Faculty, University of Cologne, 50937, Cologne, Germany

      Marek Molcanyi

    7. Department of Biomedical Engineering, Technical University of Kosice, 04000, Kosice, Slovakia

      Jozef Zivcak

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    1. Bernhard Rieger
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    2. Hongzhen Jiang
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    Corresponding author

    Correspondence to Bernhard Rieger.

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    There is no conflict of interests.

    Additional information

    B. Rieger and H. Jiang contributed equally.

    An erratum to this article is available at https://doi.org/10.1007/s00586-017-4992-z.

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    Rieger, B., Jiang, H., Ruess, D. et al. First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note. Eur Spine J 26, 3147–3155 (2017). https://doi.org/10.1007/s00586-016-4928-z

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    • DOI: https://doi.org/10.1007/s00586-016-4928-z

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