scholarly journals Does the Position of Cage Affect the Clinical Outcome of Lateral Interbody Fusion in Lumbar Spinal Stenosis?

2020 ◽  
pp. 219256822094802
Author(s):  
Guangxi Qiao ◽  
Min Feng ◽  
Jian Liu ◽  
Xiaodong Wang ◽  
Miao Ge ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Stage I ◽  
Disc Height ◽  
Stage Ii ◽  
Disc Space ◽  
Posterior Group ◽  
Indirect Decompression ◽  
Foraminal Height ◽  
Segmental Angle

Study Design: A retrospective study. Objective: This study aims to identify the ideal cage position in lateral lumbar interbody fusion (LLIF) and to investigate if the posterior instrumentation would affect the indirect decompression. Methods: Patients underwent 2-stage surgeries: stage I was LLIF and stage II was percutaneous pedicle screws fixation after 1 week. Anterior disc height (ADH), posterior disc height (PDH), left and right foraminal height (FH), and segmental angle (SA) were measured on lateral computed tomography reconstructions. The cross-sectional area of the thecal sac (CSA) was determined by the outlined area of the thecal sac on a T2-weighted axial magnetic resonance imaging. The patients were subgroups according to the cage position: the anterior (cage located at the anterior 1/3 of disc space) and posterior groups (cage located at the posterior 2/3 of disc space). P values <.05 were considered significant. Results: This study included 46 patients and 71 surgical levels. After stage I LLIF, significant increase in ADH, PDH, bilateral FH was found in both 2 subgroups, as well as the CSA (all Ps < .01). SA increased 2.84° ± 3.2° in the anterior group after stage I LLIF and increased 0.81° ± 3.1° in the posterior group ( P = .013). After stage II surgery, SA was similar between the anterior and posterior groups ( P = .20). Conclusion: The anteriorly placed cage may provide better improvement of anterior disc height and segmental angle after stand-alone LLIF surgery. After the second stage posterior instrumentation, the cage position would not affect the segmental angle or foraminal height.

scholarly journals Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?

2020 ◽  
Author(s):  
Guangxi Qiao ◽  
Min Feng ◽  
Jian Liu ◽  
Xiaodong Wang ◽  
Miao Ge ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Stage I ◽  
Disc Height ◽  
Stage Ii ◽  
Disc Space ◽  
Posterior Group ◽  
Foraminal Height ◽  
Lateral Interbody ◽  
Segmental Angle

Abstract Background: Lateral interbody fusion (LLIF) decompress the neural elements indirectly by increasing the height of disc, instead of resecting the disc or osteophytes herniated to the canal. When performing LLIF, the position of interbody cage is quite important for the outcome of decompression. This study aims to identify the ideal cage position in LLIF and to investigate if the posterior instrumentation would affect the indirect decompression. Methods: This is a retrospective study. Patients underwent 2-stage surgeries: stage I was LLIF and stage II was percutaneous pedicle screws fixation after 1 week. Anterior disc height (ADH), posterior disc height (PDH), left and right foraminal height (FH) and segmental angle (SA) were measured on lateral CT reconstructions. The cross-sectional area of the thecal sac (CSA) was determined by the outlined area of the thecal sac on a T2-weighted axial MRI. The patients were subgroups according to the cage position: the anterior (cage located at the anterior 1/3 of disc space) and posterior groups (cage located at the posterior 2/3 of disc space). P-values <0.05 were considered significant. Results: This study included 46 patients and 71 surgical levels. After stage I LLIF, significant increase in ADH, PDH, bilateral FH was found in both 2 subgroups, as well as the CSA (all p<0.01). SA increased 2.84±3.2° in anterior group after stage I LLIF and increased 0.81±3.1° in posterior group (p=0.013). After stage II surgery, SA was similar between anterior and posterior group (p=0.20). CSA showed no difference between the 2 groups. Conclusion: The anteriorly placed cage may provide better improvement of anterior disc height and segmental angle after stand-alone LLIF surgery. After the second stage posterior instrumentation, the cage position would not affect the segmental angle or foraminal height.

scholarly journals Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis

2019 ◽  
Vol 10 (5) ◽  
pp. 603-610
Author(s):  
Thiago Pereira Coutinho ◽  
Alexandre Fogaça Cristante ◽  
Raphael Martus Marcon ◽  
Ivan Dias da Rocha ◽  
Allan Hiroshi Ono ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Clinical Effect ◽  
Disc Height ◽  
Lumbar Stenosis ◽  
Resonance Imaging ◽  
Canal Area ◽  
Canal Diameter ◽  
Indirect Decompression ◽  
Clinical And Radiological Results ◽  
Access Surgery

Study Design: Prospective cohort study. Objective: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. Methods: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. Results: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% ( P < .001). The canal area increased from 109 to 149 mm2 ( P < .001) and from 9.3 to 12.2 mm ( P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides ( P < .001). The height of the foramen showed significant average increase of 2.8 mm ( P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. Conclusion: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.

scholarly journals Oblique lumbar interbody fusion in management of lumbar degenerative spinal stenosis in Chinese population

2020 ◽  
Vol 27 (2) ◽  
pp. 119-127
Author(s):  
Man Yee Cheung ◽  
Philip Cheung
Keyword(s):  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Psoas Muscle ◽  
Chinese Patients ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Lateral Incision ◽  
Oblique Lumbar Interbody Fusion ◽  
The Mean

Purpose: The purpose of this study was to assess the outcomes of a cohort of local Chinese patients who underwent oblique lumbar interbody fusion (OLIF) surgery for lumbar degenerative diseases. Methods: We adopted a minimally invasive anterior approach to the lumbar spine through retroperitoneal access. In the first part of the surgery, a 3- to 5-cm left lateral incision over the abdomen was made guided by imaging. L2–L5 disc space was approached via the corridor between the left psoas muscle and the great vessels. A specially designed interbody cage filled with bone substitute was utilized for interbody fusion. In the second part of the surgery, posterior instrumentation with or without decompression, was performed in a prone position. Efficacy and safety of the surgery were studied. Results: A total of 60 patients with the mean age of 68 years underwent OLIF at 83 surgical levels. Their mean operative time was 79 min, and the average blood loss was 84 ml for the OLIF part. The mean length of hospital stay was 5.5 days. Based on plain computed tomography scan obtained at post-operative 6 months, successful fusion was achieved in 82 of the 83 surgical levels. The Oswestry Disability Index for low back pain had a mean reduction of 22.3% after 6 months. Specific complications observed include transient thigh pain or numbness, retroperitoneal hematoma, post-operative ileus and Bone Morphogenetic Protein (BMP) osteolysis. None of the patients experienced infection, symptomatic pseudo-arthrosis, hardware failure, vascular injury, nerve injury, ureteral injury, bowel injury, incisional hernia or death. Conclusion: OLIF is an effective procedure to treat lumbar spinal stenosis and spondylolisthesis with excellent fusion rate and good functional outcome. Complications specific to this procedure are not uncommon, but majority are minor and self-recovery. Proper training is required to minimize potential surgical risks.

scholarly journals Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters

2017 ◽  
Vol 43 (2) ◽  
pp. E10 ◽  
Author(s):  
Ammar H. Hawasli ◽  
Jawad M. Khalifeh ◽  
Ajay Chatrath ◽  
Chester K. Yarbrough ◽  
Wilson Z. Ray
Keyword(s):  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Disc Space ◽  
Pelvic Parameters ◽  
Radiographic Measurements ◽  
Index Level ◽  
Segmental Lordosis ◽  
Foraminal Height

OBJECTIVEMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been adopted as an alternative technique to hasten recovery and minimize postoperative morbidity. Advances in instrumentation technologies and operative techniques have evolved to maximize patient outcomes as well as radiographic results. The development of expandable interbody devices allows a surgeon to perform MIS-TLIF with minimal tissue disruption. However, sagittal segmental and pelvic radiographic outcomes after MIS-TLIF with expandable interbody devices are not well characterized. The object of this study is to evaluate the radiographic sagittal lumbar segmental and pelvic parameter outcomes of MIS-TLIF performed using an expandable interbody device.METHODSA retrospective review of MIS-TLIFs performed between 2014 and 2016 at a high-volume center was performed. Radiographic measurements were performed on lateral radiographs before and after MIS-TLIF with static or expandable interbody devices. Radiographic measurements included disc height, foraminal height, fused disc angle, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Mismatch between pelvic incidence and lumbar lordosis were calculated for each radiograph.RESULTSA total of 48 MIS-TLIFs were performed, predominantly at the L4–5 level, in 44 patients. MIS-TLIF with an expandable interbody device led to a greater and more sustained increase in disc height when compared with static interbody devices. Foraminal height increased after MIS-TLIF with expandable but not with static interbody devices. MIS-TLIF with expandable interbody devices increased index-level segmental lordosis more than with static interbody devices. The increase in segmental lordosis was sustained in the patients with expandable interbody devices but not in patients with static interbody devices. For patients with a collapsed disc space, MIS-TLIF with an expandable interbody device provided superior and longer-lasting increases in disc height, foraminal height, and index-level segmental lordosis than in comparison with patients with static interbody devices. Using an expandable interbody device improved the Oswestry Disability Index scores more than using a static interbody device, and both disc height and segmental lordosis were correlated with improved clinical outcome. Lumbar MIS-TLIF with expandable or static interbody devices had no effect on overall lumbar lordosis, pelvic parameters, or pelvic incidence–lumbar lordosis mismatch.CONCLUSIONSPerforming MIS-TLIF with an expandable interbody device led to a greater and longer-lasting restoration of disc height, foraminal height, and index-level segmental lordosis than MIS-TLIF with a static interbody device, especially for patients with a collapsed disc space. However, neither technique had any effect on radiographic pelvic parameters.

scholarly journals The Minimally Invasive Interbody Selection Algorithm (MIISA) for Spinal Deformity

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Praveen V Mummaneni ◽  
Christopher I Shaffrey ◽  
Robert Eastlack ◽  
Juan S Uribe ◽  
Richard G Fessler ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Selection Algorithm ◽  
Disc Space ◽  
Spinal Deformity Surgery ◽  
Selection For ◽  
Segmental Lordosis ◽  
Foraminal Height

Abstract INTRODUCTION Multiple MIS interbody fusion options have been utilized as MIS deformity surgery has become more prevalent. However, at this time there is little guidance for approach selection for MIS deformity surgery. The minimally invasive interbody selection algorithm (MIISA) was created to provide a framework for rational decision making for surgeons who are considering MIS deformity surgery. METHODS A team of experienced spinal deformity surgeons developed the MIISA, incorporating the experience of a retrospective dataset from 223 MIS surgeries collected over a 5-yr period. The algorithm leads to one of 4 interbody approach options (including ALIF, ACR, LLIF, and TLIF) that allow either indirect or direct decompression of the neural elements, possibly restore disc space and foraminal height, and may restore lordosis. The algorithm was developed by fellowship-trained spine surgeons experienced with spinal deformity surgery and validated with the retrospective MIS database. RESULTS A total of 11 surgeons completed 223 MIS deformity surgeries with 661 interbody devices. These cases were reviewed and the type of interbody approach used at each level from L1-S1 was recorded. The MIISA was created with substantial agreement. Surgeons preferred lateral approaches for L1-L2, L2-L3, and L3-L4. They preferred lateral approaches at L4-L5, but this was muted by more use of TLIF and ALIF at that level. They preferred TLIF to ALIF at L5-S1. The increase in segmental lordosis at L2-L3 was significantly greater with LLIF than TLIF. The increase in segmental lordosis at L4-L5 was significantly greater with ALIF than LLIF or TLIF. The increase in segmental lordosis at L5-S1 was greater with ALIF than TLIF. CONCLUSION The use of the MIISA provides consistent and straightforward guidance for surgeons who are considering an MIS approach for the treatment of patients with adult spinal deformity. The application of this algorithm could provide a platform for surgeons to achieve the desired goals of surgery.

scholarly journals Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110374
Author(s):  
Yun-lin Chen ◽  
Xu-dong Hu ◽  
Yang Wang ◽  
Wei-yu Jiang ◽  
Wei-hu Ma
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Compact Bone ◽  
Disc Height ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Common Cause ◽  
Circumferential Fusion ◽  
Segmental Angle

Background Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage can provide circumferential fusion and biomechanical stability. However, the causes and prevention of contralateral radiculopathy following unilateral TLIF remain unclear. Methods In total, 190 patients who underwent unilateral TLIF from January 2017 to January 2019 were retrospectively reviewed. Radiological parameters including lumbar lordosis, segmental angle, anterior disc height, posterior disc height (PDH), foraminal height (FH), foraminal width, and foraminal area (FA) were measured preoperatively and postoperatively. Preoperative and postoperative visual analog scale scores were also recorded. Results The incidence of contralateral radiculopathy after unilateral TLIF was 5.3% (10/190). The most common cause was contralateral foraminal stenosis. Unilateral TLIF could increase the lumbar lordosis, segmental angle, and anterior disc height but decrease the PDH, FA, and FH in patients with symptomatic contralateral radiculopathy. The intervertebral cage should be placed to cover the epiphyseal ring and cortical compact bone of the midline, and the disc height can be increased to enlarge the contralateral foramen. Conclusion The most common cause of contralateral radiculopathy is contralateral foraminal stenosis. Careful preoperative planning is necessary to achieve satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA, and FH, resulting in contralateral radiculopathy.

scholarly journals Post-Operative Radiculitis Following One or Two Level Anterior Lumbar Surgery with or without Posterior Instrumentation

2020 ◽  
Author(s):  
Matthew S. Griffith ◽  
Kenneth A Shaw ◽  
Brian Burke ◽  
Keith Lynn Jackson ◽  
David Gloystein
Keyword(s):  
Statistical Analysis ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Lumbar Surgery ◽  
Number Of Patients ◽  
Height Change

Abstract Background: Anterior lumbar interbody fusion (ALIF) has evolved as a treatment strategy for a multitude of lumbar spine conditions. To date, two studies have identified radiculitis as a complication associated with ALIF procedures, but they do not outline a time to resolution. There have been no reports, of postoperative traction radiculitis in patients following anterior lumbar procedures.Materials and Methods: We retrospectively reviewed seventy patients who underwent anterior lumbar procedures by two surgeons. Using the Farfan ratio we calculated preoperative to postoperative change in disc height. We determined post-operative radiculitis symptoms from review of follow up notes. We also determined the type of graft used in fusion patients.Results: 70 patients were initially identified with 12 being excluded. This left 58 to be included in the study. Twenty-one patients (36.2%) developed postoperative radiculitis. There was a moderate to strong correlation with height change and radiculitis (p=0.044). Patients treated with rhBMP-2 had a rate of 36.5% post-operative radiculitis when compared to a rate of 17% for patients fused without rhBMP-2. The number of patients treated without rhBMP-2 were too few to perform statistical analysis, however. All radiculitis resolved by the 3 month follow up appointment.Conclusion: This study shows that there is a 36.2% rate of radiculitis following anterior lumbar procedures. There is a correlation between disc height change and postoperative radiculitis following anterior lumbar procedures. There also appears to be a relationship to the use of rhBMP-2. All radiculitis resolved by 3 months.

Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion(eTLIF) through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

2020 ◽  
Author(s):  
Hyeun-Sung Kim ◽  
Harshavardhan Dilip Raorane ◽  
Pang Hung Wu ◽  
Dong Hwa Heo ◽  
Yeon Jin Yi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Plain Radiograph ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Paraspinal Approach ◽  
Segmental Lordosis

Abstract Background: Implementation of endoscopic spine surgery in the management of degenerative lumbar diseases has significantly reduced the need for fusion surgeries. The performance of a MIS-TLIF using an endoscope offers some distinct advantages, such as allowing better visualization the disc space, enhanced endplate preparation and contralateral decompression. The objective of this study was to analyze the preliminary clinical and radiological outcomes of the technique of endoscopic transforaminal lumbar interbody fusion (eTLIF).Materials and Methods: eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through a conventional paraspinal approach. Their clinical outcomes were evaluated with visual analog scale(VAS) leg pain score, Oswestry Disability Index(ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis, global lumbar lordosis, disc height on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. Intra operative and post-operative complications were noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. In the X-ray result, mean segmental lordosis angle(SLA) improved in pre-operative/post-operative/follow-up period 9.87±2.74 degree/ 11.79±3.74 degree/ 10.56±3.69 degree (p > 0.01); mean lumbar lordosis angle(LLA) improved 37.1±7.04 degree/ 39.2±7.13 degree/ 35.7±7.25 degree (p > 0.01). Mean preoperative disc height(DH) improved from 8.97±1.49 mm/ 12.34±1.39 mm/ 11.44±1.98 mm (p < 0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved significantly, 7.67±1.13 / 3.39±1.38 / 2.5±1.34 and ODI was improved significantly, 74.9±8.03/ 34.56±8.80 / 27.76±8.64 by each preoperative / postoperative / final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion: According to the results of this study, endoscopic TLIF was feasible procedure with an advantage of better visualization and preservation of endplate, minimal blood loss and minimal post-operative pain with early mobilization. In addition, the fusion volume as measured on post-operative CT scans, occupied 40% to 50% of disc space along with the use of 3D printed cages expected to give higher fusion rates. In conclusion, our preliminary results show that endoscopic TLIF is considered to be a viable surgical procedure with further long-term follow-up warranted.

Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space

2010 ◽  
Vol 12 (6) ◽  
pp. 671-679 ◽  
Author(s):  
Takashi Kaito ◽  
Noboru Hosono ◽  
Yoshihiro Mukai ◽  
Takahiro Makino ◽  
Takeshi Fuji ◽  
...  
Keyword(s):  
Risk Factor ◽  
Interbody Fusion ◽  
Lumbar Disc ◽  
Japanese Orthopaedic Association ◽  
Significant Risk ◽  
Posterior Lumbar Interbody Fusion ◽  
Disc Height ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Disc Space

Object Spinal fusion at the L4–5 disc space alters the normal biomechanics of the spine, and the loss of motion at the fused level is compensated by increased motion and load at the other unfused segments. This may lead to deterioration of the adjacent segments of the lumbar spine, called adjacent-segment disease (ASD). In this study, the authors investigate the distracted disc height of the fused segment, caused by cage or bone insertion during surgery, as a novel risk factor for ASD after posterior lumbar interbody fusion (PLIF). Methods Radiographic L3–4 ASD is defined by development of spondylolisthesis greater than 3 mm, a decrease in disc height of more than 3 mm, or intervertebral angle at flexion smaller than −5°. Symptomatic ASD is defined by a decrease of 4 points or more on the Japanese Orthopaedic Association scale. Eighty-five patients with L-4 spondylolisthesis treated by L4–5 PLIF underwent follow-up for more than 2 years (mean 38.8 ± 17.1 months). The patients were divided into 3 groups according to the final outcome. Group A comprised those patients without ASD (58), Group B patients had radiographic ASD (14), and Group C patients had symptomatic ASD (13). Results The L4–5 disc space distraction by cage insertion was 3.1 mm in the group without ASD, 4.4 mm in the group with radiographic ASD, and 6.2 mm in the group with symptomatic ASD, as measured using lateral spinal radiographs just after surgery. Multivariate analysis showed that distraction was the most significant risk factor. Conclusions The excessive distraction of the L4–5 disc space during PLIF surgery is a significant and potentially avoidable risk factor for the development of radiographic, symptomatic ASD.

scholarly journals Indirect decompression with lateral interbody fusion for severe degenerative lumbar spinal stenosis: minimum 1-year MRI follow-up

2020 ◽  
Vol 33 (1) ◽  
pp. 27-34
Author(s):  
Takayoshi Shimizu ◽  
Shunsuke Fujibayashi ◽  
Bungo Otsuki ◽  
Koichi Murata ◽  
Shuichi Matsuda
Keyword(s):  
Interbody Fusion ◽  
Disc Height ◽  
Decompression Surgery ◽  
Posterior Decompression ◽  
Canal Stenosis ◽  
Indirect Decompression ◽  
Lumbar Spinal ◽  
Lateral Interbody ◽  
Over Time

OBJECTIVEThe use of indirect decompression surgery for severe canal stenosis remains controversial. The purpose of this study was to investigate the efficacy of lateral interbody fusion (LIF) without posterior decompression in degenerative lumbar spinal spondylosis with severe stenosis on preoperative MRI.METHODSThis is a retrospective case series from a single academic institution. The authors included 42 patients (45 surgical levels) who were preoperatively diagnosed with severe degenerative lumbar stenosis on MRI based on the previously published Schizas classification. These patients underwent LIF with supplemental pedicle screw fixation without posterior decompression. Surgical levels were limited to L3–4 and/or L4–5. All patients satisfied the minimum 1-year MRI follow-up. The authors compared the cross-sectional area (CSA) of the thecal sac and the clinical outcome scores (Japanese Orthopaedic Association [JOA] score) preoperatively, immediately postoperatively, and at the 1-year follow-up. Fusion status and disc height were evaluated based on CT scans obtained at the 1-year follow-up.RESULTSThe CSA improved over time, increasing from 54.5 ± 19.2 mm2 preoperatively to 84.7 ± 31.8 mm2 at 3 weeks postoperatively and to 132.6 ± 37.5 mm2 at the last follow-up (average 28.3 months) (p < 0.001). The JOA score significantly improved over time (preoperatively 16.1 ± 4.1, 3 months postoperatively 24.4 ± 4.0, and 1-year follow-up 25.7 ± 2.9; p < 0.001). The fusion rate at the 1-year follow-up was 88.8%, and disc heights were significantly restored (preoperative, 6.3 mm and postoperative, 9.6 mm; p < 0.001). Patients showing poor CSA expansion (< 200% expansion rate) at the last follow-up had a higher prevalence of pseudarthrosis than patients with significant CSA expansion (> 200% expansion rate) (25.0% vs 3.4%, p < 0.001). No major perioperative complications were observed.CONCLUSIONSLIF with indirect decompression for degenerative lumbar disease with severe canal stenosis provided successful clinical outcomes, including restoration of disc height and indirect expansion of the thecal sac. Severe canal stenosis diagnosed on preoperative MRI itself is not a contraindication for indirect decompression surgery.

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