Abstract
An advantage of lateral interbody fusion (LLIF) surgery is the resultant indirect decompression of the neural elements that occurs with disc height restoration, restoration of spinal alignment and ligamentotaxis. The degree to which indirect decompression of the spinal canal occurs varies patient to patient, and there remains no method for effectively predicting which patients will or will not respond.
In this study, we identify pre- and postoperative predictive factors of radiographic indirect decompression of the central spinal canal. The goal is to help surgeons ascertain which patients best respond to indirect decompression in the setting of lateral interbody fusion.
This is a retrospective evaluation of a prospectively and consecutively collected cohort of patients treated for degenerative etiologies at a single institution.
Patients were included if they received a minimally invasive lateral transpsoas interbody fusion by a single surgeon at our institution. Patients were treated for degenerative etiologies.
A retrospective evaluation of prospectively collected consecutive patients treated with LLIF surgery treated at a single institution without subsequent direct decompression was performed. Pre- and postoperative MRI imaging was used to grade canal stenosis and three-dimensional volumetric reconstructions were used to measure changes in the central canal area (CCA).
Multivariate regression was used to identify predictive variables that correlated with increases in CCA. Independent assessments of canal measurements were made by a blinded board-certified neuroradiologist and a spine surgeon.
Sixty-six patients with 110 levels were treated with a mean age of 68 years. Forty-six levels (42%) were treated for DDD, 36 levels (33%) for spondylolisthesis, 11 levels (10%) for adjacent segment disease and 17 levels (15%) for deformity. Preoperatively, 19 patients had moderate (29%) and 18 had severe stenosis (27%) with the remainder having mild or no stenosis. Of these 37 patients, only 4 remained severe, 4 were moderate and the rest (78%) improved to mild or no stenosis. CCA increased 41% from a mean of 1.09 to 1.55 cm2 (p<0.001). Increases in anterior disc height (73%), posterior disc height (81%), anterolisthesis (66%), right (26%) and left (22%) foraminal heights, and right (12%) and left (18%) foraminal widths (all p<0.001) were noted. No significant differences in CCA increase were noted by level or indication (p>0.05). Multivariate evaluation of predictive variables identified that preoperative anterolisthesis (p=0.002), the presence of vacuum disc phenomenon (p=0.049) and preoperative segmental lordosis (p=0.009) were independently associated with percentage increase in CCA. Age, body mass index, side of approach, pedicle screw fixation, facet grading score, presence of facet effusions, preoperative anterior and posterior disc heights, implant distance from the posterior aspect of the vertebral body and implant height all were not associated (p>0.05).
LLIF successfully achieves indirect decompression of the CCA radiographically with a mean change of 41%. Preoperative anterolisthesis on standing films, the presence of vacuum disc phenomenon on computed tomography and preoperative segmental lordosis were independently predictive factors for the percentage increase in CCA that can be achieved.
This abstract does not discuss or include any applicable devices or drugs.