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J. Alex Thomas, Christopher I. M. Thomason, Brett A. Braly, and Cristiano M. Menezes

L ateral lumbar interbody fusion (LLIF) is a minimally invasive variation of anterior lumbar interbody fusion (ALIF) that allows for powerful indirect decompression by increasing the disc height, foraminal height, and central canal diameter. 1–5 One limitation of LLIF, however, is the lack of a solution to address pathology at L5–S1. Recently, we have contributed to the development of a stepwise surgical technique to perform ALIF in the lateral decubitus position (LALIF). LALIF allows for the anterior placement of large intervertebral spacers via a minimally

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Dong Hyun Lee, Dong-Geun Lee, Jin Sub Hwang, Jae-Won Jang, Dae Hyeon Maeng, and Choon Keun Park

L umbar surgery has become an alternative strategy for use in patients who do not respond to conservative treatment. Among the many surgical choices, spinal fusion plays an important role in addressing debilitating low-back and leg pain related to continued abnormal motion of the affected segments. 1 , 2 Whereas the benefits of indirect decompression after lateral lumbar interbody fusion are well known, 3–7 and although several studies have demonstrated significant indirect foraminal decompression after anterior lumbar interbody fusion (ALIF), 8

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Takayoshi Shimizu, Shunsuke Fujibayashi, Bungo Otsuki, Koichi Murata, and Shuichi Matsuda

anterior to the psoas muscle, i.e., oblique lumbar interbody fusion. 13 , 22 , 24 Regardless of the approach, studies have shown that LIF without posterior decompression can improve neurological symptoms through “indirect decompression” that results from the restoration of intervertebral and foraminal heights. 3 , 15 , 18 However, the extent of the severity of canal stenosis, to which the indirect decompression is effective, remains unclear. If the indirect decompression is determined to be beneficial for degenerative lumbar diseases with severe canal stenosis, the

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Daehyun Park, Praveen V. Mummaneni, Ratnesh Mehra, Yonguk Kwon, Sungtae Kim, Hui Bing Ruan, and Dean Chou

morbidity of paraspinal musculature injury and potential disruption of posterior tension band. The anterior and lateral lumbar interbody approaches afford a larger interbody graft footprint and cage height options compared to the posterior approach, but there is no direct decompression with the anterior or lateral approaches alone. 11 By performing an anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF), indirect decompression may be achieved through disc height (DH) restoration, FH restoration, foraminal area (FA) increase, and distraction

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Kyeong Hwan Kim, Dong Bong Lee, Ho-Joong Kim, K. Daniel Riew, Boo Seop Kim, Bong-Soon Chang, Choon-Ki Lee, and Jin S. Yeom

reported, 13 but effective fixation of dislocation and bone union is difficult to achieve, and occipitocervical instability may occur. Li et al. 11 reported favorable results for indirect decompression without C-1 posterior arch resection via a posterior approach in prior C1–2 dislocations. These authors used skeletal traction as the main technique for reduction, and posterior instrumentation was added for maintenance of the reduction. However, they did not mention whether they achieved successful results in extremely severe cases. The current case showed severe cord

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Anthony J. Kwon, William D. Hunter, Mark Moldavsky, Kanaan Salloum, and Brandon Bucklen

manage low-grade degenerative spondylolisthesis, with favorable results. 12 It remains unclear whether implant subsidence occurs as a result of intraoperative trialing and spacer impaction, or secondary to postoperative ambulation and restoration of normal activities. An expandable spacer can potentially reduce the amount of iatrogenic morbidity caused by trialing and impaction, while achieving height restoration goals. No in vitro biomechanical studies have investigated the extent of indirect decompression or the level of endplate strength after insertion of static

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Andrew C. Vivas, Gregory M. Mundis Jr., and Juan S. Uribe

TO THE EDITOR: We read with great interest the article by Shimizu and colleagues 1 ( Shimizu T, Fujibayashi S, Otsuki B, et al. Indirect decompression with lateral interbody fusion for severe degenerative lumbar spinal stenosis: minimum 1-year MRI follow-up. J Neurosurg Spine. 2020;33[1]:27–34 ). In this article, the authors provide 1-year clinical and radiographic outcome data for patients with severe degenerative lumbar spinal stenosis who underwent indirect decompression via lateral interbody fusion. The severity of central stenosis was graded according to

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Yoshifumi Kudo, Ichiro Okano, Tomoaki Toyone, Akira Matsuoka, Hiroshi Maruyama, Ryo Yamamura, Koji Ishikawa, Chikara Hayakawa, Soji Tani, Masaya Sekimizu, Yushi Hoshino, Tomoyuki Ozawa, Toshiyuki Shirahata, Masayori Fujita, Yusuke Oshita, Haruka Emori, Hiroaki Omata, and Katsunori Inagaki

challenge of revision surgery is scar tissue formation due to previous surgery. This scar tissue might prevent adequate indirect decompression of LLIF, as shown in studies evaluating the outcomes of the primary LLIF procedure. Therefore, this study had the following two objectives: 1) to compare the clinical results, including perioperative complications of revision interbody fusion surgery, between LLIF and PLIF/TLIF by utilizing the propensity score (PS) to adjust potential confounders that influence the decision to select between the LLIF and PLIF/TLIF surgical

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Corey T. Walker, David S. Xu, Tyler S. Cole, Lea M. Alhilali, Jakub Godzik, Santiago Angel Estrada, Juan Pedro Giraldo, Joshua T. Wewel, Clinton D. Morgan, James J. Zhou, Alexander C. Whiting, S. Harrison Farber, Nikolay L. Martirosyan, Jay D. Turner, and Juan S. Uribe

decompression of the neural elements. 1–4 Indirect decompression of neural elements allows for increases in central canal and foraminal dimensions without direct bone removal, as is typically done in laminectomies, medial facetectomies, and foraminotomies. 5 This decompression results from disc height restoration, reduction of spondylolisthesis, reduction of disc bulges, elongation of a hypertrophied ligamentum flavum, correction of focal coronal and sagittal plane malalignment, and ligamentotaxis. 6–8 Although studies have shown improvement in both clinical outcomes and

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Austin Q. Nguyen, Jackson P. Harvey, Krishn Khanna, Bryce A. Basques, Garrett K. Harada, Frank M. Phillips, Kern Singh, Christopher Dewald, Howard S. An, and Matthew W Colman

durotomy, or significant intervertebral collapse due to adjacent-segment disease (ASD) may all represent difficult or suboptimal scenarios for standard revision open posterior surgery. In these cases, anterior or lateral interbody arthrodesis with indirect decompression may be a more attractive surgical option. Lumbar interbody surgical approaches often utilize alternative and less invasive surgical trajectories to the lumbar disc spaces, which tend to be less disruptive to the paraspinal musculature. In addition, they can be supported with posterior percutaneous