scholarly journals Oblique lateral interbody fusion to treat lumbar spinal stenosis in a patient with situs inversus totalis: a case report

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110328
Author(s):  
FengKai Yang ◽  
ChenTao Dou ◽  
XiaoKang Cheng ◽  
Bin Chen
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Situs Inversus ◽  
Interbody Fusion ◽  
Situs Inversus Totalis ◽  
Anatomical Structures ◽  
Lateral Interbody Fusion ◽  
Lumbar Spinal ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Oblique lateral interbody fusion (OLIF) is a minimally invasive spinal surgery that is popular for lumbar degeneration and spinal deformity treatment because it causes minimal damage to the stability of the intervertebral structures. However, when encountering abnormal anatomical structures caused by situs inversus, surgical routes must be adjusted to avoid serious complications. A 42-year-old woman with lumbar spinal stenosis presented to our hospital. Preoperative X-ray and computed tomography indicated situs inversus totalis, with the abdominal aorta and inferior vena cava reversed. We established an appropriate surgical approach for OLIF via the right abdomen according to the characteristics of the anatomical structures. Postoperative X-rays showed adequate positioning of the interbody fusion cage and internal fixation screws. At the 3-month follow-up, the patient reported resolution of her symptoms. Vascular variations caused by situs inversus totalis can affect the course of OLIF. Understanding the unique anatomical structure in such patients is crucial for successful surgery and to avoid intraoperative complications.

scholarly journals Efficacy of Indirect Decompression in Lumbar Spinal Stenosis with Stand-alone Oblique Lateral Interbody Fusion

2020 ◽  
Author(s):  
Chen Liu ◽  
Quanlai Zhao ◽  
Yu Zhang ◽  
Liang Xiao ◽  
Xin Ge ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Lateral Interbody Fusion ◽  
Indirect Decompression ◽  
Lumbar Spinal ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background Oblique lateral interbody fusion (OLIF) has been gained more and more attention in the treatment of degenerative lumbar disease. The goal of this study was to evaluate the effect of indirect decompression in lumbar spinal stenosis with stand-alone OLIF. Methods Sixty-three patients with lumbar spinal stenosis who underwent stand-alone OLIF between July 2017 and May 2018 our department were included. Clinical outcomes including visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded. Radiographic outcomes comprising of disc height (DH), foraminal height (FH) and lumbar lordosis (LL) were measured. Intraoperative data and complications were collected. All the data were compared preoperatively and postoperatively. Results Eighty-two segments were fused in sixty-three patients using stand-alone OLIF. The average follow-up time was 21.9±3.5 months (range from 16 to 28 months). The DH increased from 0.9±0.3 cm preoperatively to 1.3±0.2 cm postoperatively, and the final follow-up was 1.1±0.2 cm (P < 0.01). The FH increased from 1.7±0.3 cm before surgery to 2.3±0.3 cm after surgery, but decreased to 2.1±0.3 cm at final follow-up (P < 0.01). The LL increased from 38.0°±15.6° before surgery to 42.7°±13.0° at the final follow-up (p<0.01). The VAS and ODI scores of all patients significantly improved at the final follow-up (p<0.01). The total complication rate was 30.2%. Only three patients received revision of posterior decompression and pedicle screw fixation. Conclusions Stand-alone OLIF is an effective option in selected patients with lumbar spinal stenosis.

scholarly journals Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

2020 ◽  
Author(s):  
Jun Li ◽  
Hao Li ◽  
Zhang Ning ◽  
Zhi-wei Wang ◽  
Teng-fei Zhao ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Central Canal ◽  
Posterior Decompression ◽  
Canal Diameter ◽  
Average Change ◽  
Lumbar Spinal ◽  
Lateral Interbody

Abstract Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P- values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

scholarly journals Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

2020 ◽  
Author(s):  
Jun Li ◽  
Hao Li ◽  
Zhang Ning ◽  
Zhi-wei Wang ◽  
Teng-fei Zhao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Interbody Fusion ◽  
Central Canal ◽  
Posterior Decompression ◽  
Canal Diameter ◽  
Lumbar Spinal ◽  
Lateral Interbody

Abstract Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D.Methods: For radiographic analysis, we included 202 segments from 124 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were confronted by using Student's t-test, obtaining a statistically significant difference for values inferior to 0.05.Results: Among the 202 segments included for radiological evaluation, there were 42 grade A segments, 41 grade B segments, 101 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average changes of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression.Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments were comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

scholarly journals Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

2020 ◽  
Author(s):  
Fei-Long Wei ◽  
Cheng-Pei Zhou ◽  
Ming-Rui Du ◽  
Kai-Long Zhu ◽  
Hao-Ran Gao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Spinal Stenosis ◽  
Complication Rate ◽  
Interbody Fusion ◽  
Sf 36 ◽  
Significant Difference ◽  
Lumbar Spinal ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background: Oblique lateral interbody fusion (OLIF) expands the inner volume of the spinal canal by indirect decompression. However, there were few studies to assess OLIF for LSS. The aim of this study was to evaluate outcomes and safety after percutaneous delta endoscopic decompression (PED) and OLIF. Methods: Ninety-four patients with lumbar spinal stenosis (LSS) underwent PED or OLIF with percutaneous pedicle screw fixation (PPS) between January 2016 and December 2018 were retrospectively studied. Patients were assessed by estimated blood loss (EBL), operative time, hospital stay, cost, reoperation, complications, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), Japanese Orthopaedic Association score (JOA) and Short Form-36 (SF-36). Results: Compared with OLIF group, the OLIF group was with longer operation time and hospital stay, more blood loss and more cost (p=0.001, 0.005, 0.001 and 0.001, respectively). Compared with preoperative data, VAS and ODI were significantly reduced and JOA and SF-36 increased significantly with the statistically significant difference (all p <0.05). There was no significant difference in postoperative main outcomes except VAS (lumbar) and ODI between the two groups (all p >0.05). But patients in the PED group were with lower VAS (lumbar) and ODI (p=0.012 and 0.042, respectively). In addition, the PED group was with SF-36 physical-component summary score (p=0. 0.036). The PED group was with lower all complication rate (2.4% PED vs 9.8% OLIF), intra-operative complication rate (2.4% PED vs 3.9% OLIF) and post-operative complication rate (0.0% PED vs 5.9% OLIF), but the difference was not statistically significant (p=0.336, 0.517 and 0.402, respectively). And there was no statistical difference in and reoperation rate (2.4% PED vs 3.8% OLIF) (p= 0.715).Conclusions: PED and OLIF had satisfactory results for LSS. In general, PED was superior to OLIF in relieving patients with low back pain and improving function without any obvious shortcomings. Therefore, we recommend PED for LSS.Level of Evidence: 3

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