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

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OBJECTIVE

The 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).

METHODS

Eighty-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.

RESULTS

Of 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.

CONCLUSIONS

There 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.

ABBREVIATIONS ADH = anterior disc height; ALIF = anterior lumbar interbody fusion; CCD = central canal diameter; DH = disc height; FA = foraminal area; FD = facet joint degeneration; FH = foraminal height; LLIF = lateral lumbar interbody fusion; PDH = posterior disc height; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; XLIF = extreme lateral interbody fusion.
Article Information

Contributor Notes

Correspondence Daehyun Park: Inje University Busan Paik Hospital, Busan, Korea. spineparkdaehyun@gmail.com.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.SPINE19314.Disclosures Dr. Mummaneni is a consultant for DePuy Spine, Globus, and Stryker. He has direct stock ownership in Spinicity/ISD. He receives support for non–study-related clinical or research effort that he oversees from NREF and AOSpine. He receives royalties from DePuy Spine, Springer Publishing, and Thieme Publishers, and he receives honoraria from Spineart. Dr. Chou is a consultant for Medtronic and Globus, and receives royaltie
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