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.

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.

Minimally invasive anteroposterior combined surgery using lateral lumbar interbody fusion without corpectomy for treatment of lumbar spinal canal stenosis associated with osteoporotic vertebral collapse

2021 ◽  
pp. 1-9
Author(s):  
Kentaro Fukuda ◽  
Hiroyuki Katoh ◽  
Yuichiro Takahashi ◽  
Kazuya Kitamura ◽  
Daiki Ikeda
Keyword(s):  
Interbody Fusion ◽  
Combined Surgery ◽  
Vertebral Collapse ◽  
Short Segment ◽  
Canal Stenosis ◽  
The Mean ◽  
Osteoporotic Vertebral Collapse ◽  
Anterior Support ◽  
Lumbar Spinal

OBJECTIVE Various reconstructive surgical procedures have been described for lumbar spinal canal stenosis (LSCS) with osteoporotic vertebral collapse (OVC); however, the optimal surgery remains controversial. In this study, the authors aimed to report the clinical and radiographic outcomes of their novel, less invasive, short-segment anteroposterior combined surgery (APCS) that utilized oblique lateral interbody fusion (OLIF) and posterior fusion without corpectomy to achieve decompression and reconstruction of anterior support in patients with LSCS-OVC. METHODS In this retrospective study, 20 patients with LSCS-OVC (mean age 79.6 years) underwent APCS and received follow-up for a mean of 38.6 months. All patients were unable to walk without support owing to severe low-back and leg pain. Cleft formations in the fractured vertebrae were identified on CT. APCS was performed on the basis of a novel classification of OVC into three types. In type A fractures with a collapsed rostral endplate, combined monosegment OLIF and posterior spinal fusion (PSF) were performed between the collapsed and rostral adjacent vertebrae. In type B fractures with a collapsed caudal endplate, combined monosegment OLIF and PSF were performed between the collapsed and caudal adjacent vertebrae. In type C fractures with severe collapse of both the rostral and caudal endplates, bisegment OLIF and PSF were performed between the rostral and caudal adjacent vertebrae, and pedicle screws were also inserted into the collapsed vertebra. Preoperative and postoperative clinical and radiographical status were reviewed. RESULTS The mean number of fusion segments was 1.6. Walking ability improved in all patients, and the mean Japanese Orthopaedic Association score for recovery rate was 65.7%. At 1 year postoperatively, the mean preoperative Oswestry Disability Index of 65.6% had significantly improved to 21.1%. The mean local lordotic angle, which was −5.9° preoperatively, was corrected to 10.5° with surgery and was maintained at 7.7° at the final follow-up. The mean corrective angle was 16.4°, and the mean correction loss was 2.8°. CONCLUSIONS The authors have proposed using minimally invasive, short-segment APCS with OLIF, tailored to the morphology of the collapsed vertebra, to treat LSCS-OVC. APCS achieves neural decompression, reconstruction of anterior support, and correction of local alignment.

scholarly journals Current trends in the management of degenerative lumbar spondylolisthesis

2018 ◽  
Vol 3 (5) ◽  
pp. 192-199 ◽  
Author(s):  
Emmanuelle Ferrero ◽  
Pierre Guigui
Keyword(s):  
Surgical Treatment ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Surgical Strategy ◽  
Global Alignment ◽  
Common Disease ◽  
Posterior Decompression ◽  
Canal Stenosis ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Indirect Decompression

Degenerative spondylolisthesis (DS) is a common disease of the degenerative spine, often associated with lumbar canal stenosis. However, the choice between the different medical or surgical treatments remains under debate. Preference for surgical strategy is based on the functional symptoms, and when surgical treatment is selected, several questions should be posed and the surgical strategy adapted accordingly. One of the main goals of surgery is to improve neurological symptoms. Therefore, radicular decompression may be necessary. Radicular decompression can be performed indirectly through interbody fusion or interspinous spacer. However, indirect decompression has some limits, and the most frequent technique is a posterior decompression with fusion. Indeed, in cases of DS, associated fusion or dynamic stabilization are recommended to improve functional outcomes and prevent future destabilization. Risk factors for destabilization, such as anteroposterior and angular mobility, and significant disc height, have been discussed in the literature. When fusion is performed, osteosynthesis is often associated. It is essential to choose the length and position of the fusion according to the pelvic incidence and global alignment of the patient. It is possible to add interbody fusion to the posterolateral arthrodesis to improve graft area and stability, increase local lordosis and open foramina. The most common surgical treatment for DS is posterior decompression with instrumented fusion. Nevertheless, some cases are more complicated and it is crucial to consider the patient’s general health status, symptoms and alignment when selecting the surgical strategy. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170050

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

2013 ◽  
Vol 19 (1) ◽  
pp. 110-118 ◽  
Author(s):  
Luis Marchi ◽  
Nitamar Abdala ◽  
Leonardo Oliveira ◽  
Rodrigo Amaral ◽  
Etevaldo Coutinho ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Disc Height ◽  
Standard Group ◽  
Lateral Interbody Fusion ◽  
Cage Subsidence ◽  
Grade Ii ◽  
Wide Group ◽  
Lateral Interbody

Object Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. The influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. The authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale. Methods The study was performed as an institutional review board–approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%–24% loss of postoperative disc height; Grade I, 25%–49%; Grade II, 50%–74%; and Grade III, 75%–100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded. Results Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383). Conclusions Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.

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 Oblique Lumbar Interbody Fusion with Stand-Alone Cages for the Treatment of Degenerative Lumbar Spondylolisthesis: A Retrospective Study with 1-Year Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yachong Huo ◽  
Dalong Yang ◽  
Lei Ma ◽  
Haidong Wang ◽  
Wenyuan Ding ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Disc Height ◽  
Degenerative Lumbar Spondylolisthesis ◽  
The Mean ◽  
One Year ◽  
Psoas Major ◽  
Lumbar Spondylolisthesis ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative (P<0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle (P<0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.

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