Stand-alone lateral lumbar interbody fusion for the therapy of symptomatic adjoining section degeneration following earlier lumbar fusion.
Backbone J. 2018 Apr 18;:
Authors: Louie PK, Varthi AG, Narain AS, Lei V, Bohl DD, Shifflett GD, Phillips FM
BACKGROUND CONTEXT: Revision posterior decompression and fusion for sufferers with symptomatic ASD is related to important morbidity and is technically difficult. The usage of a stand-alone LLIF in sufferers with symptomatic ASD could keep away from lots of the issues related to revision posterior surgical procedure.
PURPOSE: To evaluate the scientific and radiographic outcomes of sufferers who underwent stand-alone lateral lumbar interbody fusion (LLIF) for symptomatic adjoining section illness (ASD).
STUDY DESIGN: Retrospective Case Sequence PATIENT SAMPLE: We retrospectively reviewed sufferers with a previous posterior instrumented fusion who underwent a subsequent stand-alone LLIF for ASD by a single surgeon. All sufferers had no less than 18 months of observe up. Sufferers have been identified with symptomatic ASD if that they had a earlier lumbar fusion with the following growth of again ache, neurogenic claudication or decrease extremity radiculopathy, within the setting of imaging which demonstrated stenosis, spondylolisthesis, kyphosis or scoliosis on the adjoining degree OUTCOME MEASURES: Affected person-reported (Oswestry Incapacity Index [ODI], Visible Analog Scale (VAS) – Again, and VAS – Leg] have been obtained at pre-operative and closing observe up visits. Radiographic parameters have been have been measured, together with: segmental and general lordosis, pelvic incidence – lumbar lordosis mismatch, coronal alignment and intervertebral disc peak.
METHODS: Scientific and radiographic outcomes have been in contrast between preoperative and closing follow-up utilizing paired t-tests. There have been no funding sources nor potential conflicts of curiosity instantly associated to the matters of the examine.
RESULTS: Twenty-five sufferers met inclusion standards. The imply age was 62.zero±11.three years. Common follow-up was 34.eight±22.four months. Fifteen (60%) underwent stand-alone LLIF surgical procedure for radicular leg ache, 7 (28%) for signs of claudication, and 25 (100.zero%) for extreme again ache. ODI scores considerably improved from pre-operative values (46.6±16.four) to closing follow-up (30.four±16.eight; p=zero.002). VAS-back (pre-op eight.four±1.zero, post-op three.2±1.9; p<zero.001), and VAS-leg (pre-op three.6±three.four, post-op 1.9±2.6; p<zero.001) scores considerably improved after surgical procedure. Segmental and regional lordosis, in addition to intervertebral disc peak have been considerably improved (p<zero.001) and maintained (p=zero.004) by the surgical procedure. Pelvic incidence – lumbar lordosis mismatch considerably improved on the first post-operative go to (p=zero.029), and this was largely maintained at the newest follow-up (p=zero.45). Six sufferers suffered from new-onset thigh weak spot after LLIF surgical procedure, however all confirmed full decision inside 6 weeks. Three sufferers required subsequent further surgical procedure, all of who have been revised to incorporate posterior instrumentation.
CONCLUSIONS: Stand-alone LLIF is a secure and efficient strategy with low morbidity and acceptable complication charges for sufferers with symptomatic ASD following a earlier lumbar fusion.
PMID: 29679730 [PubMed – as supplied by publisher]