The analysis of oblique neural decompression after lateral lumbar interbody fusion utilizing intraoperative computed tomography?myelogram.
World Neurosurg. 2018 Aug 27;:
Authors: Hayama S, Nakano A, Nakaya Y, Baba I, Fujiwara Okay, Fujishiro T, Yano T, Usami Y, Kino Okay, Obo T, Neo M
BACKGROUND: The impact of oblique decompression following lateral lumbar interbody fusion (LLIF) is broadly acknowledged; nevertheless, its particulars stay unclear. This examine aimed to judge the quick results of oblique decompression simply after LLIF cage placement however simply earlier than posterior instrumentation, utilizing intraoperative computed tomography myelogram (iCTM).
METHODS: Fifty-three ranges from 28 sufferers present process LLIF with iCTM, had been included on this retrospective examine. Radiographic parameters had been obtained from preoperative CTM and iCTM. Segmental correction, cross-sectional areas of the spinal canal (C-CSA) and bilateral foramen (F-CSA) had been in contrast preoperatively and intraoperatively to evaluate the neural decompression simply after LLIF cage placement. Canal stenosis standing throughout axial CTM was labeled into three grades in keeping with modified Schizas’s grading to find out the need of extra posterior decompression procedures. The Oswestry Incapacity Index (ODI) was obtained earlier than and three months after the operation.
RESULTS: Vital enhancements in all radiological parameters of segmental correction, C-CSA, and F-CSA had been noticed simply after LLIF cage placement. Nevertheless, 11 (21%) ranges had inadequate neural decompression standing with iCTM grade (10 central canal and one lateral recess stenosis), requiring additional direct posterior decompression. The distinction within the enchancment of ODI between decompression and non-decompression group was not important, suggesting the validity of our resolution.
CONCLUSIONS: Detailed analysis with iCTM revealed that ample oblique decompression with LLIF was not at all times obtained, validating the intraoperative resolution of additional posterior decompression. This process, LLIF with iCTM, could cut back the chance of pointless direct decompression and reoperation after inadequate oblique decompression.
PMID: 30165216 [PubMed – as supplied by publisher]