Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Abstract

Background The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion. Question/purposes We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach. Methods Between 2008 and 2012, 158 patients were surgically treated to alleviate symptoms associated with degenerative lumbar stenosis, of whom 60 (38%) were treated with lateral lumbar interbody fusion. Of these 60 patients, 36 (60%) received CT scans preoperatively and at 1-year postoperatively and were available for radiographic analysis. Of the 60 treated patients, 16 (27%) were lost to followup before 12 months, leaving the records of 44 patients available for review of patient-reported improvements in pain and return to function. Radiographic increases in disc height, foraminal area, and canal area were measured by one observer on CT scans postoperatively and at 1 year and compared to preoperative values. Patient-reported scores, including VAS pain score and Oswestry Disability Index (ODI), were collected preoperatively and at 3 and 12 months postoperatively.

Early Clinical Results of Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A New Modified Technique for Treating Degenerative Lumbar Spondylolisthesis

“…For example, in cases of degenerative scoliosis, the interbody cage can be inserted from the convex side with a wider safety zone. With the LLIF procedure, an indirect decompression effect on degenerative spondylolisthesis has been reported, which does not require direct surgery on the nerve tissue or on the epidural venous plexus [27][28][29][30] . With PETLIF, an improvement in preoperative radicular symptoms was recognized in all cases due to indirect decompression following the insertion of a cage with a height of 9 or 10 mm and correction of vertebral body spondylolisthesis using PPS.…”

L5-S1 Survival After Interbody Fusion by Lateral Approach Until L5 in Degenerative Disease

“…In the literature, this technique has already proven to be effective in treating degenerative lumbar spine diseases such as adult deformities and multilevel DDD. [14][15][16][17][18][19][20][21] A study conducted by Castro et al 15 concluded that the LLIF technique, even without posterior supplementation, was effective in treating mild adult scoliosis, providing satisfactory coronal and sagittal correction and clinical improvement of pain and function in spite of the high frequency of subsidence.…”

“…13 There are articles in the literature that show the effectiveness of using LLIF to treat degenerative scoliosis and indirect compression of neural elements. [14][15][16][17][18][19][20][21] The objective of this article is to evaluate the survival of level L5-S1 in cases of multilevel disc degeneration treated with 3-or 4-level LLIF with instrumentation to L5, with or without posterior supplementation. To do this we analyzed the rate of reoperation with extension of the arthrodesis to the sacrum or pelvis and also the possible predictive factors associated with the necessity of including L5-S1.…”

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

“…Numerous lateral procedures have been performed worldwide, and variations and technical refinements have been proposed. The procedure has also been extended to a wider range of indications, now including primary and revision surgery for degenerative problems, adult deformity, trauma, and thoracic disc herniation 52,[58][59][60][61][62][63][64][65][66][67] . The most recent advance in lateral approach surgery has received attention for its application to other spinal problems that were not indicated for original LLIF procedures.…”