Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis

Abstract

Study Design Retrospective case–control study. Purpose To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. Overview of Literature LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. Methods Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] <20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. Results Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients’ backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively ( p =0.69). Although there was no significant difference in surgical times ( p =0.58), the estimated blood loss was significantly greater in the PLIF group ( p <0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p =0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p =0.006), PI–LL (19.8°±14.8° and 3.1°±17.5°, respectively; p =0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p =0.02) were significantly better in the LLIF group. Conclusions LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

“…Lateral-access cage insertion techniques via the retroperitoneal space have been invented to reduce the problems related to TLIF procedures, including lateral lumbar interbody fusion (LLIF) or oblique lateral interbody fusion (OLIF) [ 2 , 4 , 7 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. LLIF is conducted via the intermuscular approach dissecting the psoas muscle; thus, it can cause psoas muscle-related complications, including anterior thigh pain, leg weakness, nerve root injury, and others [ 2 , 4 , 11 , 13 , 14 , 25 , 29 ]. To overcome the problems of LLIF, the OLIF procedure has been recently developed.…”

Lateral lumbar interbody fusion in adult spine deformity – A review of literature

“…Dawkar et al [16] in 2010, reported significant improvement of sagittal balance after LLIF procedure and were probably amongst the first authors to do so. Over the last few years, there have been numerous case series on the success of LLIF for spondylolisthesis, adjacent segment disease, scoliosis, stenosis and kyphosis [17][18][19][20].…”

“…Many authors have reported LLIF as an excellent management option for adult spinal deformity [17][18][19][20]. Sembrano et al [21] in their study of 147 patients with spinal deformity and sagittal imbalance, compared four approaches ALIF, LLIF, TLIF and posterior spinal fusion, PSF.…”

“…Higher grade osteotomies [25] increase the surgical insult and is associated with greater blood loss and morbidity. In our review, we found 5 studies [19,20,[29][30][31] treating severe deformity with the use of lateral lumbar fusion. In each of these five studies, all the patients underwent more than 3 levels of lateral lumbar fusion with a combined 197 patients and 898 operated level.…”

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

“…MIS-LLIF has shown promising outcomes in minimizing the approach-related morbidity. It can minimize soft tissue injury, decrease blood loss, and shorten hospital stay while maintaining the equivalent or improved clinical and radiographic outcomes as compared to the open procedures [ 67 - 69 ]. Sagittal and coronal deformity correction can be performed with large and lordotic cages [ 70 - 74 ].…”