Lateral Lumbar Interbody Fusion and <i>in Situ</i> Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

Abstract

ObjectiveThe purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease.MethodsThe medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.ResultsThe median follow-up period was 13 months (range, 3–48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients.ConclusionThis study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?

“…This revision method can shorten the operation time and decrease bleeding. The radiological findings showed that the segmental angle and anterior disc height were significantly improved [14].…”

“…Louie et al selected stand-alone LLIF to treat symptomatic ASD [13]. Choi et al reported that LLIF supplemented with lateral screw fixation was an alternative surgical option for ASD [14]. Segmental and regional lordosis, as well as intervertebral disc height, were improved and remained stable after the surgery.…”

Biomechanical Evaluation of strategies for Adjacent Segment Disease after Lateral lumbar interbody fusion: is extension of pedicle screw necessary?

“…This revision method can shorten the operation time and decrease the bleeding. The radiological findings showed that the segmental angle and anterior disc height were significantly improved [12].…”

“…The reoperation choice is often quite diverse and now we lack some high-quality clinical proofs for superiority of any surgical treatment. Choi et al reported LLIF supplemented with lateral screw fixation is an alternative surgical option for ASD [12]. Louie et al selected stand-alone LLIF to treat symptomatic ASD [13].…”

Three cases of adjacent segment disease post‐posterior spinal fusion, treated successfully by oblique lateral interbody fusion: A clinical series

“…4 Against this background, some surgeons suggested that the use of lumbar lateral interbody fusion may provide effective treatment of symptomatic ASD. 3,5,6 Here, we report three cases with symptomatic ASD after posterior fixation, which were salvaged by oblique lateral interbody fusion (OLIF) surgery.…”