A Novel Capsule Lumbar Interbody Fusion (CLIF) in Treating Foot Drop due to Lumbar Degenerative Diseases: a Prospective, Observational Study

Abstract

Objective. This present study aimed to explore the clinical effects of a novel capsule lumbar interbody fusion (CLIF) on foot drop due to lumbar degenerative diseases. Methods. Between June 2018 and January 2019, a total of 27 patients admitted to our department with lumbar degenerative diseases with associated foot drop were prospectively enrolled. Given the selection of surgical technique, patients were divided into traditional TLIF group and CLIF group. We assessed patients’ neurological status using JOA and VAS score, tibialis anterior muscle strength using MMT score, diameter and hemodynamic parameters of the L5 nerve root using intraoperative ultrasonography (IoUS), and related radiological parameters of the lumbar spine. Operation time, blood loss, and surgery-associated complications were also recorded. Results. The median duration of follow-up was 150 (6–1460) months. At the final follow-up, all patients acquired satisfactory improvement of neurological function. However, patients in the CLIF group showed better early recovery of foot drop three months after operation than those in the TLIF group, with 75% excellent rate. In addition, IoUS suggested that the diameter and hemodynamic parameters of the L5 nerve root were improved better in the CLIF group, which may suggest the correlation between the recovery of foot drop and the status of L5 nerve root. No severe complications were encountered with CLIF. Conclusions. Our preliminary study revealed that the axial tension of L5 nerve root may be involved in the pathological mechanism of foot drop. The novel technique of CLIF can shorten the lumbar spine and can be effective and safe for the treatment of foot drop due to lumbar degeneration-related diseases.

Clinical Outcomes of a Novel Capsule Lumbar Interbody Fusion (CLIF) in Delayed Surgical Treatment of Cauda Equina Syndrome Retention (CESR) due to Lumbar Disc Herniation

“…Why? We speculated that, with the exception of compression and ischemia of nerve, the high axial nerve tension was another important injury mechanism [9,10]. During the operation of this study, it was found that the dural sac and nerve root of all CESR patients had relatively high tension (judged by the clinical experience of the surgeons).…”

“…The above ndings revealed that compression injury caused by LDH might not be the sole cause of cauda equina nerve injury. Our previous studies have also found that high axial nerve tension injury may cause serious nerve function damage alone or in combination with compression injury [9,10]. Therefore, we speculated that CESR patients might have compression injury and high axial nerve tension injury at the same time.…”

“…Therefore, we speculated that CESR patients might have compression injury and high axial nerve tension injury at the same time. Based on the above considerations, we proposed a novel lumbar surgery: capsule lumbar interbody fusion (CLIF), which can effectively reduce the tension of the nerve, and then obtain a better clinical effect [9]. However, it is still unclear whether CLIF is effective for the delayed treatment of CESR.…”