Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up

OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. METHODS This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation. RESULTS The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995). CONCLUSIONS There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

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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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Efficacy and radiographic analysis of oblique lumbar interbody fusion for degenerative lumbar spondylolisthesis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1416-2 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Menghui Wu ◽

Jia Li ◽

Mengxin Zhang ◽

Xufeng Ding ◽

Dongxu Qi ◽

...

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Radiographic Analysis ◽

Lumbar Interbody Fusion ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Oblique Lumbar Interbody Fusion ◽

Lumbar Spondylolisthesis

Abstract Background To compare the clinical efficacy and radiographic analysis of oblique lumbar interbody fusion (OLIF) and traditional posterior lumbar interbody fusion (PLIF) in treating degenerative lumbar spondylolisthesis (DLS). Methods Grade I DLS patients admitted to the Third Hospital of Hebei Medical University were retrospectively reviewed. In sum, 78 patients that underwent OLIF (n = 31) and PLIF (n = 47) treatment of DLS were recruited. Clinical data including clinical and radiological evaluations were collected pre-operatively and at each follow-up. Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), lumbar lordosis (LL), disc height (DH), and fusion rates were compared between the OLIF and PLIF groups. Results The operation time for both groups was 131.3 ± 14.6 min in the OLIF group and 156.9 ± 37.4 min in the PLIF group (P < 0.001). The intraoperative blood loss was 163.6 ± 63.9 ml in the OLIF group and 496.8 ± 122.6 ml in the PLIF group (P < 0.001). The length of the surgical incision was 4.63 ± 0.57 cm in the OLIF group and 11.83 ± 1.37 cm in the PLIF group (P < 0.001). The number of intraoperative and post-operative complications for both groups was 10 in the OLIF group and 20 in the PLIF group. Significant clinical improvement (P < 0.05) was observed in JOA scores and ODI when comparing pre-operative evaluation and final follow-up. After statistical analysis, there was no significant difference in the preoperative JOA scores between the two groups. There was no significant difference when comparing pre-operative LL and DH for either group. Post-operative reexamination was improved as compared to pre-operative exams. And the improvement of DH was better in the OLIF group as compared to the PLIF group. Conclusions For DLS patients, both OLIF and PLIF can achieve good results. Furthermore, OLIF displays marked advantages including smaller surgical incisions, shorter anesthesia times, decreased intraoperative blood loss, and post-operative pain better relieved.

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The Influence of Endplate Morphology on Cage Subsidence in Patients With Stand-Alone Oblique Lateral Lumbar Interbody Fusion (OLIF)

Global Spine Journal ◽

10.1177/2192568221992098 ◽

2021 ◽

pp. 219256822199209

Author(s):

Ziang Hu ◽

Dengwei He ◽

Jiawei Gao ◽

Zhongyou Zeng ◽

Chao Jiang ◽

...

Keyword(s):

Interbody Fusion ◽

Disc Height ◽

Treatment Level ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Cage Subsidence ◽

Disability Questionnaire ◽

First Time ◽

The Relationship

Study Design: A retrospective study of prospectively collected radiographic and clinical data. Objective: This study aims to investigate the relationship between endplate morphology parameters and the incidence of cage subsidence in patients with mini-open single-level oblique lateral lumbar interbody fusion (OLIF). Methods: We included 119 inpatients who underwent OLIF from February 2015 to December 2017. A total of 119 patients with single treatment level of OLIF were included. Plain anteroposterior and lateral radiograph were taken preoperatively, postoperatively, and during follow-up. The correlation between disc height, endplate concave angle/depth, cage position and cage subsidence were investigated. Functional rating index (Visual Analogue Scale for pain, and Roland Morris Disability Questionnaire) were employed to assess clinical outcomes. Results: Cage subsidence was more commonly seen at the superior endplates (42/119, 35.29%) than at the inferior endplates (6/119, 5.04%) (p < 0.01). More importantly, cage subsidence was significantly less in patients with superior endplates that were without concave angle (3/20, 15%) than with concave angle (37/99, 37.37%) (p < 0.05). Cage subsidence correlated negatively with preoperative anterior disc height (r = −0.21, p < 0.05), but positively with disc distraction rate (r = 0.27, p < 0.01). Lastly, the distance of cage to the anterior edges of the vertebral body showed a positive correlation (r = 0.26, p < 0.01). Conclusions: This study for the first time demonstrated that endplate morphology correlates with cage subsidence after OLIF. Since relatively flat endplates with smaller concave angle significantly diminish the incidence of subsidence, the morphology of cage surface should be taken into consideration when designing the next generation of cage. In addition, precise measurement of the disc height to avoid over-distraction, and more anteriorly placement of the cage is suggested to reduce subsidence.

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Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion: A Technical Note With 1-Year Follow-Up

The International Journal of Spine Surgery ◽

10.14444/8072 ◽

2021 ◽

pp. 8072

Author(s):

Zhen-Zhou Li ◽

Jin-Chang Wang ◽

Zheng Cao ◽

Hong-Liang Zhao ◽

Kai-Uwe Lewandrowski ◽

...

Keyword(s):

Interbody Fusion ◽

Technical Note ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Early Postoperative Loss of Disc Height Following Transforaminal and Lateral Lumbar Interbody Fusion: A Radiographic Analysis

Asian Spine Journal ◽

10.31616/asj.2021.0109 ◽

2021 ◽

Author(s):

Arun-Kumar Kaliya-Perumal ◽

Tamara Lee Ting Soh ◽

Mark Tan ◽

Jacob Yoong-Leong Oh

Keyword(s):

Interbody Fusion ◽

Disc Height ◽

Radiographic Analysis ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Incidence of adjacent-segment surgery following stand-alone lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2020.12.spine201218 ◽

2021 ◽

pp. 1-5

Author(s):

Gautam Nayar ◽

Souvik Roy ◽

Waseem Lutfi ◽

Nitin Agarwal ◽

Nima Alan ◽

...

Keyword(s):

Interbody Fusion ◽

Smoking Status ◽

Lumbar Fusion ◽

Adjacent Segment ◽

Study Cohort ◽

Lumbar Interbody Fusion ◽

Retrospective Diagnosis ◽

Lateral Lumbar Interbody Fusion ◽

Kaplan Meier

OBJECTIVE Adjacent-segment disease (ASD) requiring operative intervention is a relatively common long-term consequence of lumbar fusion surgery. Although the incidence of ASD requiring reoperation is well described for traditional posterior lumbar approaches (2.5%–3.9% per year), it remains poorly characterized for stand-alone lateral lumbar interbody fusion (LLIF). In this study, the authors report their institutional experience with ASD requiring reoperation after LLIF over an extended follow-up period of 4 years. METHODS Medical records were reviewed for 276 consecutive patients who underwent stand-alone LLIF by a single surgeon for degenerative spinal disorders. Inclusion criteria (single-stage, stand-alone LLIF without posterior supplementation, with no prior lumbar instrumentation, and a minimum of 4 years of follow-up) were met by 182 patients, who were analyzed for operative ASD incidence (per-year rate), demographics, and Oswestry Disability Index (ODI) score. Operative ASD was strictly defined as new-onset pathology following index surgery at directly adjacent levels to the prior construct. Operative, rather than symptomatic or radiographic, ASD was analyzed to provide a consistent and impactful endpoint while avoiding retrospective diagnosis. RESULTS The study cohort of 182 patients had an operative ASD rate of 3.3% (n = 6 procedures) over 4 years of follow-up, for an incidence on Kaplan-Meier survival analysis of 0.88% (95% CI 0.67%–1.09%) per year. In comparing patients with operative ASD with those without, there were no significant differences in mean age (53.7 vs 56.2 years), male sex (33.3% vs 44.9%), smoking status (16.7% vs 25.0%), or number of levels fused (mean 1.33 vs 1.46). The operative ASD cohort had a greater mean BMI (37.3 vs 30.2, p < 0.01). Operative ASD patients had lower baseline ODI scores (33.8 vs 48.3, p = 0.02); however, no difference was observed in ODI at 6 weeks (34.0 vs 39.0) or 3 months (16.0 vs 32.8) postoperatively. CONCLUSIONS The incidence of ASD in LLIF for degenerative lumbar etiologies in this cohort was 0.88% (95% CI 0.67%–1.09%) per year. Meanwhile, the reported reoperation rates for ASD in posterior spinal approaches was 2.5% to 3.9% per year, which implies that LLIF may be preferable for well-selected patients.

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Comparative Effectiveness of Adjustable Lordotic Expandable Versus Static Lateral Lumbar Interbody Fusion Devices: Two-Year Clinical and Radiographic Outcomes

Neurosurgery ◽

10.1093/neuros/nyz310_822 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Yan M Li ◽

Richard F Frisch ◽

Zheng Huang ◽

James Towner ◽

Yan Icy Li ◽

...

Keyword(s):

Back Pain ◽

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Radiographic Outcomes ◽

Pain Scores ◽

Institutional Review ◽

Mean Differences ◽

Static Group

Abstract INTRODUCTION Use of large interbody spacers in minimally invasive lateral lumbar interbody fusion (MIS LLIF) commonly offers favorable clinical and radiographic results. Expandable interbody spacers with adjustable lordosis offer in Situ expansion that may optimize endplate contact and maximize/maintain sagittal correction until fusion occurs. This study compares clinical and radiographic outcomes between patients treated with static and expandable interbody spacers with adjustable lordosis for MIS LLIF. METHODS This is a multi-surgeon, retrospective, institutional review board-exempt chart review of consecutive patients who underwent MIS LLIF at 1 to 2 contiguous level (s) using either PEEK static (27 patients) or titanium expandable spacer with adjustable lordosis (24 patients). Mean differences of radiographic/clinical functional outcomes were collected/compared from preoperative to 24-mo postoperative follow-up. Statistical results were significant if P < .05. RESULTS Mean improvement of visual analog scale (VAS) back pain scores from preoperative to 6, 12, 24 mo was significantly higher in expandable group compared to static group (P < .05). Oswestry Disability Index (ODI) score mean improvement from preoperative to 3, 6, 12, 24 mo was significantly higher in expandable group compared to static group (P < .05). Expandable group had significantly greater mean improvement in segmental lordosis from preoperative to 6 wk, 3, 6, and 12 mo (P < .05). For disc height, mean improvement from preoperative to 24 mo was more significant in static group compared to expandable group (P < .05). Neuroforaminal height mean improvement from preoperative to 6 wk, 3 and 6 mo was significantly greater in expandable group compared to static group (P < .05). Subsidence was 0% in expandable group and 18.5% in static group. CONCLUSION This study showed significant positive clinical and radiographic outcomes for patients who underwent MIS LLIF using titanium expandable interbody spacers with adjustable lordosis based on significant changes in VAS back pain scores, ODI scores, and radiographic parameters at 24-mo follow-up.

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