Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion

Abstract

Background: To assess the clinical outcomes of 44 patients who underwent single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw instrumentation through a paramedian Wiltse approach.Methods: Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative plain radiographs were assessed for subsidence, cage migration, and fusion.Results: Average age of patients at surgery was 60.8±10.6 years (range, 32-79 years), with 15 males and 29 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was used in 32 cases (73%) and 13 posterolateral fusions (30%). Average duration of surgery was 195.2±36.9 minutes (range: 111-295 minutes), with an estimated blood loss of 159.3±90.8 cc (range, 50-500 cc). There were no intra-operative complications.Average length of hospital stay was 4.2±2.5 days (range, 2-13 days). Four patients (9%) experienced neurological deficit, 2 of which resolved by 3-month follow-up and 2 of which improved but did not resolve by final follow-up at 11 and 16 months. There was significant improvement in VAS (P<0.001), ODI (P<0.001), and SF-12 physical component (P<0.001), but not for SF-12 mental component (P=0.053). Patients with minimum 6 months radiographic follow-up demonstrated successful fusion in 90% of cases (35/39), with 2 cases of grade 1 (5%) subsidence of the adjacent cranial vertebra, and no cases higher than grade 0 subsidence of the adjacent caudal vertebra.Conclusions: Unilateral pedicle screw instrumentation following LLIF was associated with significant improvement in clinical outcomes and favorable radiographic outcomes.

Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis

“…According to previous studies, both OLIF and LLIF presented lower postoperative VAS and ODI scores compared with preoperative values [8, 9, 38, 39], which is consistent with our results. Furthermore, we have found the postoperative VAS and ODI scores in the OLIF group were better than those in the LLIF group (− 3.25 versus − 2.18; − 3.06 versus − 1.76, respectively), probably due to complications related to the psoas muscle injury in the LLIF group.…”

“…Pooled analysis of nine studies treated with OLIF [3, 8–11, 14, 16, 21, 22] showed that the pooled mean of ODIs varies across studies (I 2 = 94.8%), and the pooled SMD was − 3.06 (95% CI, − 4.03 to − 2.08). Pooled analysis of eighteen studies treated with LLIF [5, 10, 26, 27, 30, 33, 34, 36–38, 46, 48, 49, 51–54, 57] showed that the pooled mean of ODIs varies across studies (I 2 = 83.9%), and the pooled SMD was − 1.76 (95% CI, − 2.08 to − 1.43) (Fig. 4a and b).…”

“…Five studies about OLIF [8, 12, 19, 21, 22] with a total of 287 patients and fusion was reported in 278 patients. Twelve studies about LLIF [30, 38–40, 46, 47, 49, 51, 52, 54, 55, 57] with a total of 584 patients and fusion was reported in 535 patients.…”

Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

“…Therefore, if LLIF with unilateral instrumentation can obtain similar results to bilateral instrumentation, this would greatly simplify the procedure and obviate a posture change. Currently, there was a few studies evaluating clinical outcomes about LLIF with unilateral instrumentation 19,20 . However, there have been no reports which directly compared clinical outcomes of LLIF between unilateral and bilateral instrumentation.…”

A Comparative Study of a New Retractor‐Assisted WILTSE TLIF, MIS‐TLIF, and Traditional PLIF for Treatment of Single‐Level Lumbar Degenerative Diseases

“…Numerous studies have reported clinical advantages of the Wiltse approach and MIS‐TLIF in treating degenerative lumbar diseases (blood loss 50–180 ml, hospital stay 2–5 days) 9 , 10 . However, MIS‐TLIF still has the limitations of long fluoroscopy time and a long learning curve and causes tissue trauma to some extent due to the specific tubular compression to the muscle during the operation 5 , 11 .…”