The Ideal Cage Position for Achieving Both Indirect Neural Decompression and Segmental Angle Restoration in Lateral Lumbar Interbody Fusion (LLIF)

Park, Se-Jun; Lee, Chong-Suh; Chung, Sung-Soo; Kang, Sang-Soo; Park, Hyunjin; Kim, Se‐Hun

doi:10.1097/bsd.0000000000000406

Cited by 68 publications

(92 citation statements)

References 24 publications

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“…LLIF decompress the neural elements indirectly by increasing disc height, instead of resecting disc and bony structure which lead to stenosis. The increase of the height of foraminal area (FA) and of the cross-sectional area of the thecal sac (CSA) will lead to indirect decompression of the nerve roots and dural sac, which has been reported by previous studies (3,4).…”

Section: Introductionmentioning

confidence: 73%

“…The benefit of LLIF on SA has been reported in many studies. Park et al (4). reported greater increase in anterior disc height and SA when the cage was placed in the anterior 1/3 area than in the middle 1/3 area.…”

Section: Discussionmentioning

confidence: 97%

“…Thus, it is somehow controversial for the position of the cage in the LLIF surgery. Park et al (4). reported that the cage within the anterior 1/3 of disc space could benefit achieving the restoration of the SA without compromising the indirect neural decompression.…”

Section: Introductionmentioning

confidence: 99%

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Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?

Qiao

Feng

Liu

et al. 2020

Preprint

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Background: Lateral interbody fusion (LLIF) decompress the neural elements indirectly by increasing the height of disc, instead of resecting the disc or osteophytes herniated to the canal. When performing LLIF, the position of interbody cage is quite important for the outcome of decompression. This study aims to identify the ideal cage position in LLIF and to investigate if the posterior instrumentation would affect the indirect decompression. Methods: This is a retrospective study. Patients underwent 2-stage surgeries: stage I was LLIF and stage II was percutaneous pedicle screws fixation after 1 week. Anterior disc height (ADH), posterior disc height (PDH), left and right foraminal height (FH) and segmental angle (SA) were measured on lateral CT reconstructions. The cross-sectional area of the thecal sac (CSA) was determined by the outlined area of the thecal sac on a T2-weighted axial MRI. The patients were subgroups according to the cage position: the anterior (cage located at the anterior 1/3 of disc space) and posterior groups (cage located at the posterior 2/3 of disc space). P-values <0.05 were considered significant. Results: This study included 46 patients and 71 surgical levels. After stage I LLIF, significant increase in ADH, PDH, bilateral FH was found in both 2 subgroups, as well as the CSA (all p<0.01). SA increased 2.84±3.2° in anterior group after stage I LLIF and increased 0.81±3.1° in posterior group (p=0.013). After stage II surgery, SA was similar between anterior and posterior group (p=0.20). CSA showed no difference between the 2 groups. Conclusion: The anteriorly placed cage may provide better improvement of anterior disc height and segmental angle after stand-alone LLIF surgery. After the second stage posterior instrumentation, the cage position would not affect the segmental angle or foraminal height.

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Section: Introductionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 97%

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Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?

Qiao

Feng

Liu

et al. 2020

Preprint

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“…Although the indirect neural decompression effect of LLIF for lumbar stenosis has been addressed in previous studies [3,4,[9][10][11][12][13], the purpose of the current study was to evaluate the indirect neural decompression effect in patients with extreme lumbar spinal stenosis. The average changes in CD and CCA of grade D were 2.50 ± 1.25 mm and 16.11 ± 10.70 mm 2 , which were comparable with the effects in other grades, and indicated that the indirect decompression effect is not compromised in patients with extreme spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Zhang

et al. 2020

BMC Musculoskelet Disord

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Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lateral lumbar interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas' classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P-values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

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“…However, patients with extreme lumbar spinal stenosis are not good candidates for LLIF alone. Stand-alone LLIF is not suggested for such patients, but with concomitant posterior decompression, LLIF can achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis.Although the indirect neural decompression effect of LLIF for lumbar stenosis has been addressed in previous studies[3,4,[9][10][11][12][13], the purpose of the current study was to evaluate the indirect neural decompression effect in patients with extreme lumbar spinal stenosis. The average changes in CD and CCA of grade D were 2.50 ± 1.25 mm and 16.11 ± 10.70 mm 2 , which were comparable with the effects in other grades, and indicated that the indirect decompression effect is not compromised in patients with extreme spinal stenosis.…”

mentioning

confidence: 99%

Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Zhang

et al. 2020

Preprint

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Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P- values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

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The Ideal Cage Position for Achieving Both Indirect Neural Decompression and Segmental Angle Restoration in Lateral Lumbar Interbody Fusion (LLIF)

Abstract: The cage position within the anterior 1/3 of disk space is better for achieving the restoration of the SA without compromising the indirect neural decompression, if the height of cage is large enough.

Cited by 68 publications

References 24 publications

Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?

Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

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