Factors Affecting Slip Reduction in Oblique Lumbar Interbody Fusion With Posterior Fixation for Degenerative Spondylolisthesis

Abstract

Study Design: Retrospective case series Objectives: Reduction of translational/angular slip is a favorable radiological result in spinal fusion for degenerative spondylolisthesis, although its clinical significance remains controversial. Few studies have investigated slip reduction and associated factors in oblique lumbar interbody fusion (OLIF) for degenerative spondylolisthesis. Methods: This study involved a retrospective analysis of 56 operated levels of 52 consecutive patients who underwent OLIF for degenerative spondylolisthesis and had more than 1-year of regular follow-up. Translational/angular slip, anterior/posterior disc height, and spinopelvic parameters were measured preoperatively, postoperatively at 6-weeks, and at the last follow-up. Demographic, radiological, and surgical parameters were analyzed to determine factors associated with the amount of slip reduction. Result: The mean follow-up duration was 30.4 ± 12.9 months (range, 12 to 61). The mean decrease in translational slip was 5.7 ± 2.1 mm (13.6 ± 5.5%) and the mean increase in angular slip was 7.9 ± 7.1° at the last follow-up (both P < 0.001). The amount of slip reduction was greater in female sex, age < 65 years, use of a 12° cage, cage position from the anterior disc margin of < 7 mm, and cases with posterior decompression (laminectomy with inferior facetectomy). Conclusions: OLIF showed satisfactory translational/angular slip reduction in degenerative spondylolisthesis. Surgical techniques for optimal reduction include the use of a large angle cage, anterior cage placement, and resection of the inferior facet.

Reduction Capacity and Factors Affecting Slip Reduction Using Cortical Bone Trajectory Technique in Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

“…Because instrumentation failure is the result of a complex combination of factors, the reduction maneuver itself may go unrecognized as a possible cause. This study showed a comparable or superior slip reduction rate to those reported in previous studies 3,[18][19][20][21][22][23][24] . (Table 3) One reason for the favorable results may be that the preoperative vertebral slip, which was identified as a factor contributing to the slip reduction rate in this study, was not as large as in other Spine Surgery and Related Research J-STAGE Advance Publication (February 10, 2022) Ⓒ The Japanese Society for Spine Surgery and Related Research.…”

“…In terms of factors related to slip reduction, little is known about what determines the degree of reduction during arthrodesis for LDS. Chung et al investigated slip reduction and associated parameters in oblique lumbar interbody fusion combined with posterior screw fixation 22) . They revealed that three factors significantly affected slip reduction: age <65 years, anterior cage placement, and resection of the inferior facet.…”

“…Secondly, in cases with larger preoperative vertebral slip, wider neural decompression is necessary because indirect decompression following complete slip reduction may not be expected. Resection of the bilateral facet joint becomes a valid option to achieve segmental mobility, as Chung et al reported 22) .…”

Long‐Term Clinical and Imaging Results of Oblique Lateral Interbody Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta‐Analysis

“…Moreover, previous literature reports addressing this issue have predominantly been published in only the past 2 years. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] In addition, most published studies focused more on short-term efficacy after surgery but did not investigate or discuss, in depth, whether the long-term efficacy and safety of OLIF are stable. 16,25,26 Most meta-analyses of interbody fusion in recent years have also focused on early postoperative efficacy and ignored long-term efficacy.…”

A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction

“…The incidence of neurological deficits, such as nerve root, cauda equina, and peripheral nerve palsy, has been reported as high as 45%, although 90% of cases eventually improve upon follow-up [5,10,16,21]. Besides traction injury to the L5 nerve root during the reduction process, other possible mechanisms of L5 palsy include neurovascular dysfunction, foraminal morphometry, temporary displacement of the L5 nerve root during decompression, and hyperextension of the patient during positioning [4,9,11,19,21]. In order to minimize postoperative L5 nerve palsy after reduction of high-grade spondylolisthesis, several authors hypothesize that most of the total L5 nerve strain occurs during the second half of reduction, and therefore suggest a reduction of no more than 50% and/or decompression of the L5 nerve roots prior to reduction [10,13,20].…”