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Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients – Lumbar Spinal Stenosis

The article compares the clinical and radiographic outcomes of lateral lumbar interbody fusion (LLIF) with direct and indirect decompression in patients with degenerative lumbar diseases. The study included 28 patients who underwent single-level LLIF, with half receiving direct decompression and half indirect decompression. While both groups showed significant clinical improvements postoperatively, there were no significant differences between the two groups in terms of clinical outcomes. Radiographic outcomes were also similar, except for an increase in cross-sectional area being significantly greater in the direct decompression group. The indirect decompression group had lower blood loss and shorter operative time, suggesting that direct decompression may not be necessary for some patients undergoing LLIF

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established day surgery unit in the world

Published article

CONCLUSION: Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.

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Neurospine. 2024 Mar;21(1):342-351. doi: 10.14245/ns.2346906.453. Epub 2024 Mar 31. ABSTRACT OBJECTIVE: To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases. METHODS: Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect,

Neurospine. 2024 Mar;21(1):342-351. doi: 10.14245/ns.2346906.453. Epub 2024 Mar 31.

ABSTRACT

OBJECTIVE: To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases.

METHODS: Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect decompression (group I). Clinical outcomes including the Oswestry Disability index and visual analogue scale of back and leg pain were collected. Radiographic outcomes including cross-sectional area (CSA) of thecal sac, disc height, foraminal height, foraminal area, fusion rate, segmental, and lumbar lordosis were measured.

RESULTS: Twenty-eight patients who met the inclusion criteria were eligible for the analysis, with a distribution of 14 subjects in each group. The average age was 66.1 years. Postoperatively, significant improvements were observed in all clinical parameters. However, these improvements did not show significant difference between both groups at all follow-up periods. All radiographic outcomes were not different between both groups, except for the increase in CSA which was significantly greater in group D (77.73 ± 20.26 mm2 vs. 54.32 ± 35.70 mm2, p = 0.042). Group I demonstrated significantly lower blood loss (68.13 ± 32.06 mL vs. 210.00 ± 110.05 mL, p < 0.005), as well as shorter operative time (136.35 ± 28.07 minutes vs. 182.18 ± 42.67 minutes, p = 0.002). Overall complication rate was not different.

CONCLUSION: Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.

PMID:38569646 | DOI:10.14245/ns.2346906.453

The London Spine Unit : most established day surgery unit in the world

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Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients

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Neurospine. 2024 Mar;21(1):342-351. doi: 10.14245/ns.2346906.453. Epub 2024 Mar 31. ABSTRACT OBJECTIVE: To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases. METHODS: Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect

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