P133. Is preoperative resolution of leg pain at rest a predictor for successful indirect decompression in anterior and lateral lumbar interbody fusion?

Abstract Spondylolisthesis is a common cause of lower back and leg pain in adults. The initial treatment for patients is typically nonoperative in nature. However, when patients fail conservative management and their back and/or leg pain is recalcitrant, surgical intervention is warranted. Spinal decompression, either directly or indirectly, as well as fusion is often considered at this point. There are numerous approaches to fuse the spine, including anterior, lateral, or posterior, each with their own advantages and disadvantages. This video illustrates a case of symptomatic spondylolisthesis occurring after laminectomy treated by lateral lumbar interbody fusion for indirect decompression and stabilization. The approach utilizes 3-dimensional navigation rather than traditional fluoroscopy, resulting in markedly decreased radiation exposure for the surgeon and staff while maintaining accuracy. Appropriate patient consent was obtained. This video demonstrates the technique for a lateral lumbar interbody fusion using navigation assistance, which is a minimally invasive technique for the treatment of spondylolisthesis.

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Patient-reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion

Spine ◽

10.1097/brs.0000000000003535 ◽

2020 ◽

Vol 45 (18) ◽

pp. E1172-E1178

Author(s):

Hiroaki Nakashima ◽

Tokumi Kanemura ◽

Kotaro Satake ◽

Kenyu Ito ◽

Satoshi Tanaka ◽

...

Keyword(s):

Quality Of Life ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Patient Reported ◽

Indirect Decompression

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Lateral lumbar interbody fusion without intraoperative neuromonitoring: a single-center consecutive series of 157 surgeries

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18588 ◽

2019 ◽

Vol 30 (4) ◽

pp. 439-445 ◽

Cited By ~ 1

Author(s):

Sandro M. Krieg ◽

Lukas Bobinski ◽

Lucia Albers ◽

Bernhard Meyer

Keyword(s):

Interbody Fusion ◽

Intraoperative Neuromonitoring ◽

Sensory Deficit ◽

Leg Pain ◽

Csf Leak ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Motor Weakness ◽

Lateral Lumbar Interbody Fusion ◽

The Mean

OBJECTIVELateral lumbar interbody fusion (LLIF) is frequently used for anterior column stabilization. Many authors have reported that intraoperative neuromonitoring (IONM) of the lumbar plexus nerves is mandatory for this approach. However, even with IONM, the reported motor and sensory deficits are still considerably high. Thus, the authors’ approach was to focus on the indication, trajectory, and technique instead of relying on IONM findings per se. The objective of this study therefore was to analyze the outcome of our large cohort of patients who underwent LLIF without IONM.METHODSThe authors report on 157 patients included from 2010 to 2016 who underwent LLIF as an additional stabilizing procedure following dorsal instrumentation. LLIF-related complications as well as clinical outcomes were evaluated.RESULTSThe mean follow-up was 15.9 ± 12.0 months. For 90.0% of patients, cage implantation by LLIF was the first retroperitoneal surgery. There were no cases of surgery-related hematoma, vascular injury, CSF leak, or any other visceral injury. Between 1 and 4 cages were implanted per surgery, most commonly at L2–3 and L3–4. The mean length of surgery was 92.7 ± 35 minutes, and blood loss was 63.8 ± 57 ml. At discharge, 3.8% of patients presented with a new onset of motor weakness, a new sensory deficit, or the deterioration of leg pain due to LLIF surgery. Three months after surgery, 3.5% of the followed patients still reported surgery-related motor weakness, 3.6% leg pain, and 9.6% a persistent sensory deficit due to LLIF surgery.CONCLUSIONSThe results of this series demonstrate that the complication rates for LLIF without IONM are comparable, if not superior, to those in previously reported series using IONM. Hence, the authors conclude that IONM is not mandatory for LLIF procedures if the surgical approach is tailored to the respective level and if the visualization of nerves is performed.

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Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Neurosurgical FOCUS ◽

10.3171/2017.10.focus17566 ◽

2018 ◽

Vol 44 (1) ◽

pp. E6 ◽

Cited By ~ 12

Author(s):

Peter G. Campbell ◽

Pierce D. Nunley ◽

David Cavanaugh ◽

Eubulus Kerr ◽

Philip Andrew Utter ◽

...

Keyword(s):

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Sensory Loss ◽

Motor Deficit ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Indirect Decompression ◽

The Mean

OBJECTIVERecently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4–5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4–5 level.METHODSThe authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months.RESULTSFifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively.CONCLUSIONSThis study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4–5. The use of this surgical approach provides a minimally invasive solution that offers excellent arthrodesis rates as well as favorable clinical and radiological outcomes, with low rates of postoperative complications. However, adhering to the techniques of transpsoas lateral surgery, such as minimal table break, an initial look-and-see approach to the psoas, clear identification of the plexus, minimal cranial caudal expansion of the retractor, mobilization of any traversing sensory nerves, and total psoas dilation times less than 20 minutes, ensures the lowest possible complication profile for both visceral and neural injuries even in the narrow safe zones when accessing the L4–5 disc space in patients with degenerative spondylolisthesis.

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An Algorithm to Predict Success of Indirect Decompression Using the Extreme Lateral Lumbar Interbody Fusion Procedure

Cureus ◽

10.7759/cureus.317 ◽

2015 ◽

Cited By ~ 1

Author(s):

Brandon C Gabel ◽

Reid Hoshide ◽

William Taylor

Keyword(s):

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Fusion Procedure ◽

Lateral Lumbar Interbody Fusion ◽

Indirect Decompression

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Lateral lumbar interbody fusion after reduction using the percutaneous pedicle screw system in the lateral position for Meyerding grade II spondylolisthesis: a preliminary report of a new lumbar reconstruction strategy

10.21203/rs.3.rs-29930/v4 ◽

2021 ◽

Author(s):

Masanari Takami ◽

Ryo Taiji ◽

Motohiro Okada ◽

Akihito Minamide ◽

Hiroshi Hashizume ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Visual Analog Scale Score ◽

Lateral Position ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Percutaneous Pedicle Screw ◽

Indirect Decompression ◽

Grade Ii ◽

The Mean

Abstract Background: Utilization of a cage with a large footprint in lateral lumbar interbody fusion (LLIF) for the treatment of spondylolisthesis leads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological results of patients with spondylolisthesis of Meyerding grade II.Methods: Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 15.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rods were placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws so that they expanded the anteroposterior width of the interbody space. At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. Results: The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed using computed tomography 12 months after surgery.Conclusion: For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due to the narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely.Trial registration: UMIN-Clinical Trials Registry, UMIN000040268, Registered 29 April 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938

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Lateral Lumbar Interbody Fusion After Reduction Using the Percutaneous Pedicle Screw System in the Lateral Position for Meyerding Grade II Spondylolisthesis: A Preliminary Report of a New Lumbar Reconstruction Strategy

10.21203/rs.3.rs-29930/v1 ◽

2020 ◽

Author(s):

Masanari Takami ◽

Ryo Taiji ◽

Motohiro Okada ◽

Akihito Minamide ◽

Hiroshi Hashizume ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Visual Analog Scale Score ◽

Lateral Position ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Percutaneous Pedicle Screw ◽

Indirect Decompression ◽

Grade Ii ◽

The Mean

Abstract Background:Utilization of a cage with a large footprint in lateral lumbar interbody fusion(LLIF) for the treatment of spondylolisthesisleads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological resultsof patients with spondylolisthesis of Meyerding grade II.Methods:Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 12.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rodswere placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws sothat they expanded the anteroposterior width of the interbody space.At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. Results:The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed in all four patients who could be followed up for more than 12 months.Conclusion:For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due tothe narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely.Trial registration:UMIN-Clinical Trials Registry, UMIN000040268,Registered 29 April 2020,https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938

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Predictors of the need for laminectomy after indirect decompression via initial anterior or lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2019.11.spine19314 ◽

2020 ◽

Vol 32 (6) ◽

pp. 781-787

Author(s):

Daehyun Park ◽

Praveen V. Mummaneni ◽

Ratnesh Mehra ◽

Yonguk Kwon ◽

Sungtae Kim ◽

...

Keyword(s):

Back Pain ◽

Interbody Fusion ◽

Symptom Duration ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Staged Surgery ◽

Vas Score ◽

Lateral Lumbar Interbody Fusion ◽

Indirect Decompression ◽

Facet Joint Degeneration

OBJECTIVEThe goal of this study was to evaluate factors that are associated with the need for additional posterior direct decompressive surgery after anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF).METHODSEighty-six adult patients who underwent ALIF or LLIF for degenerative spondylolisthesis and foraminal stenosis were enrolled. Patient factors (age, sex, number of surgery levels, and visual analog scale [VAS] score for leg and back pain); procedure-related factors (cage height and lordosis); and radiographic measurements (disc height [DH]; foraminal height [FH], foraminal area [FA], central canal diameter [CCD], and facet joint degeneration [FD]) were analyzed. All patients underwent staged surgery on 2 different days, with the anterior portion first, followed by the posterior portion.RESULTSOf 86 patients, 62 underwent posterior decompression and 24 had no posterior decompression. There were no significant differences between groups with regard to age, sex, preoperative VAS score for back pain, cage height, cage angulation, preoperative DH, FH, FA, CCD, and FD (p > 0.05). The group that underwent posterior decompression showed statistically different numbers of treated segments (1.92 vs 1.21, p < 0.01), preoperative VAS leg score (7.9 vs 6.3), symptom duration (14.2 months vs 9.4 months), postoperative DH improvement (61.3% vs 96.2%), postoperative FH improvement (21.5% vs 32.1%), postoperative FA improvement (24.1% vs 36.9%), and cage height minus preoperative DH (5.3 mm vs 7.5 mm) compared with the nondecompression group.CONCLUSIONSThere appears to be some correlation between the need for posterior decompression and the number of treated segments, VAS leg scores, symptom duration, FH, FA, and difference between the cage height and preoperative DH. In selected patients undergoing staged surgery, indirect decompression without direct decompression may be a reasonable option in treating degenerative spinal conditions.

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