Indirect Decompression Effect to Central Canal and Ligamentum Flavum After Extreme Lateral Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion

Limthongkul, Worawat; Tanasansomboon, Teerachat; Yingsakmongkol, Wicharn; Tanaviriyachai, Terdpong; Radcliff, Kris E.; Singhatanadgige, Weerasak

doi:10.1097/brs.0000000000003521

Cited by 48 publications

(44 citation statements)

References 16 publications

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“…OLIF as an indirect neural decompression had a satisfactory clinical outcome for degenerative spine disease [19,27,36]. The current study had similar results with previous studies.…”

Section: Discussionsupporting

confidence: 88%

Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

Wei

Zhou

et al. 2020

Preprint

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Background: Oblique lateral interbody fusion (OLIF) expands the inner volume of the spinal canal by indirect decompression. However, there were few studies to assess OLIF for LSS. The aim of this study was to evaluate outcomes and safety after percutaneous delta endoscopic decompression (PED) and OLIF. Methods: Ninety-four patients with lumbar spinal stenosis (LSS) underwent PED or OLIF with percutaneous pedicle screw fixation (PPS) between January 2016 and December 2018 were retrospectively studied. Patients were assessed by estimated blood loss (EBL), operative time, hospital stay, cost, reoperation, complications, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), Japanese Orthopaedic Association score (JOA) and Short Form-36 (SF-36). Results: Compared with OLIF group, the OLIF group was with longer operation time and hospital stay, more blood loss and more cost (p=0.001, 0.005, 0.001 and 0.001, respectively). Compared with preoperative data, VAS and ODI were significantly reduced and JOA and SF-36 increased significantly with the statistically significant difference (all p <0.05). There was no significant difference in postoperative main outcomes except VAS (lumbar) and ODI between the two groups (all p >0.05). But patients in the PED group were with lower VAS (lumbar) and ODI (p=0.012 and 0.042, respectively). In addition, the PED group was with SF-36 physical-component summary score (p=0. 0.036). The PED group was with lower all complication rate (2.4% PED vs 9.8% OLIF), intra-operative complication rate (2.4% PED vs 3.9% OLIF) and post-operative complication rate (0.0% PED vs 5.9% OLIF), but the difference was not statistically significant (p=0.336, 0.517 and 0.402, respectively). And there was no statistical difference in and reoperation rate (2.4% PED vs 3.8% OLIF) (p= 0.715).Conclusions: PED and OLIF had satisfactory results for LSS. In general, PED was superior to OLIF in relieving patients with low back pain and improving function without any obvious shortcomings. Therefore, we recommend PED for LSS.Level of Evidence: 3

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“…OLIF as an indirect neural decompression had a satisfactory clinical outcome for degenerative spine disease [19,27,36]. The current study had similar results with previous studies.…”

Section: Discussionsupporting

confidence: 88%

Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

Wei

Zhou

et al. 2020

Preprint

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“…Our finding that expansion of DH associated with an increment in central canal decompression was supported by previous studies. The multivariate analysis showed that cage morphology and position were not associated with the percentage change of SCSA, similar conclusions were reported 11,12,21) .…”

Section: Factor Associated With Central Spinal Canal Decompressionsupporting

confidence: 83%

Do Obliquity and Position of the Oblique Lumbar Interbody Fusion Cage Influence the Degree of Indirect Decompression of Foraminal Stenosis?

Mahatthanatrakul

Kotheeranurak

Lin

et al. 2022

J Korean Neurosurg Soc

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Objective : Oblique lumbar interbody fusion (OLIF) is a surgical technique that utilizes a large interbody cage to indirectly decompress neural elements. The position of the cage relative to the vertebral body could affect the degree of foraminal decompression. Previous studies determined the position of the cage using plain radiographs, with conflicting results regarding the influence of the position of the cage to the degree of neural foramen decompression. Because of the cage obliquity, computed tomography (CT) has better accuracy than plain radiograph for the measurement of the obliquely inserted cage. The objective of this study is to find the correlation between the position of the OLIF cage with the degree of indirect decompression of foraminal stenosis using CT and magnetic resonance imaging (MRI).Methods : We review imaging of 46 patients who underwent OLIF from L2-L5 for 68 levels. Segmental lordosis (SL) was measured in a plain radiograph. The positions of the cage were measured in CT. Spinal canal cross-sectional area (SCSA), and foraminal crosssectional area (FSCA) measurements using MRI were taken into consideration.Results : Patients’ mean age was 69.7 years. SL increases 3.0±5.1 degrees. Significant increases in SCSA (33.3%), FCSA (43.7% on the left and 45.0% on the right foramen) were found (p<0.001). Multiple linear regression analysis shows putting the cage in the more posterior position correlated with more increase of FSCA and decreases SL correction. The position of the cage does not affect the degree of the central spinal canal decompression. Obliquity of the cage does not result in different degrees of foraminal decompression between right and left side neural foramen.Conclusion : Cage position near the posterior part of the vertebral body increases the decompression effect of the neural foramen while putting the cage in the more anterior position correlated with increases SL.

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“…To the authors' knowledge, this complication has not been reported and discussed. Numerous studies have described the powerful phenomenon of indirect decompression of the neural elements using lateral or anterior interbody cages [16][17][18]. The reports describe Case Reports in Orthopedics how interbody cages can increase disk height, foraminal height, and cross-sectional area of the spinal canal and foramina.…”

Section: Discussionmentioning

confidence: 99%

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

Neal

Kalani

Lyons

2021

Case Reports in Orthopedics

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The anterior lumbar interbody fusion (ALIF) is a well-established procedure used to treat a multitude of spinal pathologies. When performed at the L5-S1 level, the ALIF is often supplemented with posterior pedicle screw and rod fixation. Because the interbody device can restore disk and foraminal height, one benefit of the ALIF procedure is indirect neural decompression in the spinal canal and neural foramina. If the contour of the posterior rod is not matched to the exact position of the tulip heads on the pedicle screws, spondylolisthesis can be introduced, leading to foraminal stenosis and nerve compression. This concern is particularly germane when the posterior instrumentation is placed percutaneously without any direct foraminal decompression. In this report, we describe a patient who had an L4-S1 ALIF, resulting in new L5-S1 retrolisthesis and worsening L5 radiculopathy. Technical nuances and avoidance strategies are discussed.

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Indirect Decompression Effect to Central Canal and Ligamentum Flavum After Extreme Lateral Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion

Cited by 48 publications

References 16 publications

Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

Do Obliquity and Position of the Oblique Lumbar Interbody Fusion Cage Influence the Degree of Indirect Decompression of Foraminal Stenosis?

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

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