Indirect decompression with lateral interbody fusion for severe degenerative lumbar spinal stenosis: minimum 1-year MRI follow-up

Restricted access

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

OBJECTIVE

The 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.

METHODS

This 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.

RESULTS

The 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.

CONCLUSIONS

LIF 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.

ABBREVIATIONS CSA = cross-sectional area; DH-m = disc height at the middle of the vertebral body; DH-p = disc height at the posterior edge of the vertebral body; EBL = estimated blood loss; JOA = Japanese Orthopaedic Association; LIF = lateral interbody fusion; SDA = segmental disc angle.
Article Information

Contributor Notes

Correspondence Takayoshi Shimizu: Kyoto University Graduate School of Medicine, Kyoto, Japan. takayosh@kuhp.kyoto-u.ac.jp.INCLUDE WHEN CITING Published online March 13, 2020; DOI: 10.3171/2020.1.SPINE191412.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Ahmadian ABach KBolinger B Stand-alone minimally invasive lateral lumbar interbody fusion: multicenter clinical outcomes. J Clin Neurosci. 2015;22(4):740746.

    • Search Google Scholar
    • Export Citation
  • 2

    Alimi MHofstetter CPCong GT Radiological and clinical outcomes following extreme lateral interbody fusion. J Neurosurg Spine. 2014;20(6):623635.

    • Search Google Scholar
    • Export Citation
  • 3

    Aichmair ALykissas MGGirardi FP An institutional six-year trend analysis of the neurological outcome after lateral lumbar interbody fusion: a 6-year trend analysis of a single institution. Spine (Phila Pa 1976). 2013;38(23):E1483E1490.

    • Search Google Scholar
    • Export Citation
  • 4

    Fujibayashi SHynes RAOtsuki B Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976). 2015;40(3):E175E182.

    • Search Google Scholar
    • Export Citation
  • 5

    Fujibayashi SKawakami NAsazuma T Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine (Phila Pa 1976). 2017;42(19):14781484.

    • Search Google Scholar
    • Export Citation
  • 6

    Fujiwara AKobayashi NSaiki K Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36. Spine (Phila Pa 1976). 2003;28(14):16011607.

    • Search Google Scholar
    • Export Citation
  • 7

    Ghogawala ZDziura JButler WE Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):14241434.

    • Search Google Scholar
    • Export Citation
  • 8

    Glassman SGornet MFBranch C MOS Short Form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Spine J. 2006;6(1):2126.

    • Search Google Scholar
    • Export Citation
  • 9

    Kepler CKSharma AKHuang RC Indirect foraminal decompression after lateral transpsoas interbody fusion. J Neurosurg Spine. 2012;16(4):329333.

    • Search Google Scholar
    • Export Citation
  • 10

    Kotwal SKawaguchi SLebl D Minimally invasive lateral lumbar interbody fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech. 2015;28(4):119125.

    • Search Google Scholar
    • Export Citation
  • 11

    Marchi LAbdala NOliveira L Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine. 2013;19(1):110118.

    • Search Google Scholar
    • Export Citation
  • 12

    Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine (Phila Pa 1976). 1997;22(6):691700.

    • Search Google Scholar
    • Export Citation
  • 13

    Mehren CMayer HMZandanell C The oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications. Clin Orthop Relat Res. 2016;474(9):20202027.

    • Search Google Scholar
    • Export Citation
  • 14

    Ohtori SOrita SYamauchi K Change of lumbar ligamentum flavum after indirect decompression using anterior lumbar interbody fusion. Asian Spine J. 2017;11(1):105112.

    • Search Google Scholar
    • Export Citation
  • 15

    Oliveira LMarchi LCoutinho EPimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976). 2010;35(26)(suppl):S331–S337.

    • Search Google Scholar
    • Export Citation
  • 16

    Ozgur BMAryan HEPimenta LTaylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435443.

    • Search Google Scholar
    • Export Citation
  • 17

    Patel NPBirch BDDement SEElbert GA. The mini-open anterolateral approach for degenerative thoracolumbar disease. Clin Neurol Neurosurg. 2010;112(10):853857.

    • Search Google Scholar
    • Export Citation
  • 18

    Pereira EAFarwana MLam KS. Extreme lateral interbody fusion relieves symptoms of spinal stenosis and low-grade spondylolisthesis by indirect decompression in complex patients. J Clin Neurosci. 2017;35:5661.

    • Search Google Scholar
    • Export Citation
  • 19

    Rouben DCasnellie MFerguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech. 2011;24(5):288296.

    • Search Google Scholar
    • Export Citation
  • 20

    Schizas CTheumann NBurn A Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010;35(21):19191924.

    • Search Google Scholar
    • Export Citation
  • 21

    Sharma AKKepler CKGirardi FP Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech. 2011;24(4):242250.

    • Search Google Scholar
    • Export Citation
  • 22

    Silvestre CMac-Thiong JMHilmi RRoussouly P. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J. 2012;6(2):8997.

    • Search Google Scholar
    • Export Citation
  • 23

    Walker CTFarber SHCole TS Complications for minimally invasive lateral interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches. J Neurosurg Spine. 2019;30(4):446460.

    • Search Google Scholar
    • Export Citation
  • 24

    Woods KRBillys JBHynes RA. Technical description of oblique lateral interbody fusion at L1–L5 (OLIF25) and at L5–S1 (OLIF51) and evaluation of complication and fusion rates. Spine J. 2017;17(4):545553.

    • Search Google Scholar
    • Export Citation
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 526 526 526
Full Text Views 87 87 87
PDF Downloads 81 81 81
EPUB Downloads 0 0 0
PubMed
Google Scholar