An Algorithm to Predict Success of Indirect Decompression Using the Extreme Lateral Lumbar Interbody Fusion Procedure

Abstract

Purpose: The purpose of this study is to define an algorithm that will predict the success of indirect decompression without the need for direct decompression in patients undergoing lateral lumbar interbody fusions.Methods and Materials: A prospective cohort study was undertaken for patients undergoing indirect decompression with lateral lumbar interbody fusion. Patients had to meet the following criteria prior to indirect fusion: lack of facet fusion on CT, absence of free disc fragment or compressive facet joint cyst on MRI, absence of frank osteoporosis, lack of congenital and/or severe spinal stenosis on MRI, and significant reduction (greater than 50%) in leg and back pain at rest. We then assessed which patients at follow-up required a second stage open decompression procedure because of continued back and/or leg pain. Results: Our series included 28 patients who underwent indirect decompression with extreme lateral lumbar interbody fusion. Of the 28 patients, one patient required a second stage open decompression at follow-up. The most common level operated on was the L4-L5 level. Twelve patients underwent more than a single level fusion. Average preoperative lumbar lordosis was 29 degrees and average postoperative lordosis was 45 degrees. The average patient age was 66.3 years and average follow-up was 1.21 years. Conclusions: Our algorithm can be used as an aid to assess which patients may benefit from indirect decompression alone, compared to indirect decompression combined with posterior decompression procedures.

Mola parcial con feto vivo, complicado con restricción de crecimiento intrauterino y preeclamsia severa. Reporte de caso y revisión de la literatura

“…Sitio del estudio: un total de 5 estudios fueron realizados en Estados Unidos (13,(20)(21)(22)(23), tres en India (24)(25)(26), dos en México (27,28), dos en China (29,30) (29,32,38,41), de 28 a 37 semanas 6 casos (24,27,36,37,39) y 37 semanas o más en 4 casos (13,26,31). El método de diagnóstico fue ultrasonido prenatal en 21 casos (20,21,(23)(24)(25)27,28,30,(32)(33)(34)(35)37,40,(42)(43), y en el alumbramiento o por patología, 10 casos (13,26,29,31,36,38,39,41,43). Se ofreció terminación del embarazo en 4 casos (20,23).…”

“…La edad gestacional al momento de la terminación del embarazo osciló entre las 15 y las 40 semanas: de 22 semanas o menos, 9 casos (20,22,23,28,40); de 23 a 27 semanas, 4 casos (29,32,34,38); de 28 a 37 semanas, 13 casos (21,24-25-26-28,30,33,36,39,41,42-43) y de 38 a 42 semanas, 5 casos (13,26,31,35,37). Respecto al tipo de parto: parto por cesárea, 12 casos (8,21,26,27,(30)(31)(32)(33)(34)39,42,43), parto vaginal, 10 casos (13,25,28,29,(35)(36)(37)41,42).…”

Rate of failure of indirect decompression in lateral single-position surgery: clinical results

“…In this series, 3 indirect decompression failures (1.7%) were observed, the lowest failure rate reported in studies in which there were no apparent exclusions of patients on the basis of degree or etiology of stenosis. 1,[15][16][17] No elements of the technique, specific to the technique of ALIF in the lateral decubitus position, were identified that would otherwise allow for the relatively low rate of indirect decompression failure. 11 Rather, given the complete commitment to indirect decompression in this consecutive patient series (with no exclusions of patients based on stenosis), this rate suggests a true representation of the effectiveness of indirect decompression.…”

“…However, patients with free disc fragments, facet cysts, and severe stenosis were excluded. 17 The notion of exclusion of patients with severe spinal stenosis is an interesting one. In the most cited paper on indirect decompression in LLIF, Oliveira et al reported on 21 patients who underwent stand-alone LLIF.…”

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

“…Moreover, factors that are less likely to influence indirect decompression in LLIF are cage position, cage type, side of approach, Fig. 6 A 66-year-old woman suffering from contralateral iliopsoas hematoma (arrow) preoperative sagittal/coronal alignment, presence of facet arthropathy, spinal level (upper or lower lumbar spine), and number of operated spinal levels [9,21,[23][24][25][26].…”