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Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

Authors Kleiner J, Kleiner H, Grimberg E, Throlson S

Received 8 November 2015

Accepted for publication 15 February 2016

Published 13 May 2016 Volume 2016:9 Pages 105—114

DOI https://doi.org/10.2147/MDER.S100098

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Feng Wei

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson

The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA

Study design: Disk material removed (DMR) during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF) surgery was compared to the corresponding bone graft (BG) volumes inserted at the time of fusion. A novel BG delivery tool (BGDT) was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD). This study was performed prospectively.
Summary of background data: Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified.
Methods: A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD.
Results: DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute.
Conclusion: The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk relative to AD.

Keywords: T-LIF, diskectomy, bone graft, lumbar fusion, minimally invasive spinal surgery, pseudoarthrosis

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