Dataset Information

Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature.

ABSTRACT:

Background

In the past decade, lateral lumbar interbody fusion (LLIF) has gained in popularity. A proposed advantage is the achievement of indirect neural decompression. However, evidence of the effectiveness of LLIF in neural decompression in lumbar degenerative conditions remains unclear.

Questions/purposes

We sought to extrapolate clinical and radiological results and consequently the potential benefits and limitations of LLIF in indirect neural decompression in degenerative lumbar diseases.

Methods

We conducted a systematic review of the literature in English using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain were extracted, as were data on the following radiological measurements: disc height (DH), foraminal height (FH), foraminal area (FA), central canal area (CA).

Results

In the 42 articles included, data on 2445 patients (3779 levels treated) with a mean follow-up of 14.8 ± 5.9 months were analyzed. Mean improvements in VAS back, VAS leg, and ODI scale scores were 4.1 ± 2.5, 3.9 ± 2.2, and 21.9 ± 7.2, respectively. Post-operative DH, FH, FA, and CA measurements increased by 68.6%, 21.9%, 37.7%, and 29.3%, respectively.

Conclusion

Clinical results indicate LLIF as an efficient technique in indirect neural decompression. Analysis of radiological data demonstrates the effectiveness of symmetrical foraminal decompression. Data regarding indirect decompression of central canal and lateral recess are inconclusive and contradictory. Bony stenosis appears as an absolute contraindication. The role of facet joint degeneration is unclear. This systematic review provides a reference for surgeons to define the potential and limitations of LLIF in indirect neural elements decompression.

SUBMITTER: Formica M

PROVIDER: S-EPMC7253558 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature.

Formica Matteo M Quarto Emanuele E Zanirato Andrea A Mosconi Lorenzo L Vallerga Davide D Zotta Irene I Baracchini Maddalena Lontaro ML Formica Carlo C Felli Lamberto L

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20200320 2

<h4>Background</h4>In the past decade, lateral lumbar interbody fusion (LLIF) has gained in popularity. A proposed advantage is the achievement of indirect neural decompression. However, evidence of the effectiveness of LLIF in neural decompression in lumbar degenerative conditions remains unclear.<h4>Questions/purposes</h4>We sought to extrapolate clinical and radiological results and consequently the potential benefits and limitations of LLIF in indirect neural decompression in degenerative lu ...[more]

PMID: 32523482

Similar Datasets

Project description:BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures.MethodsA systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF.ResultsSeven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001).ConclusionsThe above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF.Trial registrationPROSPERO ID: CRD42020201903 .

Project description:IntroductionDespite that lateral lumbar interbody fusion (LLIF) is a minimally invasive surgery, some patients complain of severe site pain immediately after the surgery. This study aimed to explore the extent of perioperative pain after LLIF, compare the degree of perioperative pain after LLIF with that after other surgical procedures, and evaluate the factors associated with severe pain in the early postoperative period.MethodsIn this study, 93 patients who underwent lumbar spine surgeries for lumbar degenerative diseases were analyzed. The patients were categorized into three groups based on the surgical procedure: Group L, LLIF with percutaneous pedicle screw (PPS); Group P, posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF); and Group D, posterior decompression (fenestration). The extent of low back pain was evaluated using the visual analog scale (VAS) preoperatively and from postoperative days 1 to 14.ResultsThe VAS score for postoperative pain decreased in a time-dependent manner in all three groups (P<0.01). Repeated measures analysis of variance (ANOVA) showed that the VAS in Group L was significantly higher than that in Group D (P<0.01). Time point analysis revealed that the VAS scores from postoperative days 1 to 9 in Group L were significantly higher than those in Group D (P<0.05). No significant difference was observed in the VAS scores of postoperative pain between Groups L and P on all postoperative days. The VAS score for early postoperative pain in Group L was significantly correlated with the change in disc height index (P<0.05, r=0.43) and tended to be associated with the grade of preoperative disc degeneration and the VAS score of preoperative low back pain (P=0.076-0.19).ConclusionsThis study is the first to evaluate the factors associated with pain during the early postoperative period of LLIF. Although LLIF is a minimally invasive surgery, severe pain may develop in patients with significant preoperative disc degeneration or following spinal correction surgery.

Dataset Information

Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature.

Background

Questions/purposes

Methods

Results

Conclusion

Publications

Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature.

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