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

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.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion

2021 ◽  
pp. 1-7
Author(s):  
Austin Q. Nguyen ◽  
Jackson P. Harvey ◽  
Krishn Khanna ◽  
Bryce A. Basques ◽  
Garrett K. Harada ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Preoperative Imaging ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Posterior Decompression ◽  
Less Invasive ◽  
Lateral Lumbar Interbody Fusion ◽  
Reoperation Rates

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.

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

2018 ◽  
Vol 44 (1) ◽  
pp. E6 ◽  
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.

scholarly journals 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

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

scholarly journals 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

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

Single-Position Surgery: Prone Lateral Lumbar Interbody Fusion: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ifije E Ohiorhenuan ◽  
Jakub Godzik ◽  
Juan S Uribe
Keyword(s):  
Informed Consent ◽  
Prone Position ◽  
Interbody Fusion ◽  
Operative Time ◽  
Illustrative Case ◽  
Anterior Fusion ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Lateral Decubitus

Abstract Lateral lumbar interbody fusion (LLIF) is a widely used technique for anterior fusion. However, posterior decompression or instrumentation often requires repositioning the patient, which increases operative time. This video describes the prone LLIF as a modification of the standard surgical technique. The prone LLIF facilitates simultaneous decompression and fusion, which avoids the need for repositioning the patient, increasing operative efficiency. Positioning, fluoroscopic considerations, and operative nuances involved in performing the LLIF in the prone position are described, and an illustrative case is presented. The patient provided informed consent for the procedure and videography. LLIF in the prone position can decrease operative time and increase operative efficiency. The prone position is a viable alternative to the conventional lateral decubitus position. Video used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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

Neurosurgery ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document