Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion

Comparison of instrumented and stand-alone lateral lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis

BACKGROUND

Both instrumented and stand-alone lateral lumbar interbody fusion (LLIF) have been widely used to treat lumbar degenerative disease. However, it remains controversial as whether posterior internal fixation is required when LLIF is performed. This meta-analysis aims to compare the radiographic and clinical results between instrumented and stand-alone LLIF.

METHODS

PubMed, EMBASE and Cochrane Collaboration Library up to March 2023 were searched for studies that compared instrumented and stand-alone LLIF in the treatment of lumbar degenerative disease. The following outcomes were extracted for comparison: interbody fusion rate, cage subsidence rate, reoperation rate, restoration of disc height, segmental lordosis, lumbar lordosis, visual analog scale (VAS) scores of low-back and leg pain and Oswestry Disability Index (ODI) scores.

RESULTS

13 studies involving 1063 patients were included. The pooled results showed that instrumented LLIF had higher fusion rate (OR 2.09; 95% CI 1.16-3.75; P = 0.01), lower cage subsidence (OR 0.50; 95% CI 0.37-0.68; P < 0.001) and reoperation rate (OR 0.28; 95% CI 0.10-0.79; P = 0.02), and more restoration of disc height (MD 0.85; 95% CI 0.18-1.53; P = 0.01) than stand-alone LLIF. The ODI and VAS scores were similar between instrumented and stand-alone LLIF at the last follow-up.

CONCLUSIONS

Based on this meta-analysis, instrumented LLIF is associated with higher rate of fusion, lower rate of cage subsidence and reoperation, and more restoration of disc height than stand-alone LLIF. For patients with high risk factors of cage subsidence, instrumented LLIF should be applied to reduce postoperative complications.

Durability of stand-alone anterolateral interbody fusion in staged minimally invasive circumferential scoliosis surgery with delayed posterior instrumentation due to medical necessity

PURPOSE

Circumferential minimally invasive scoliosis surgeries are often staged, wherein anterior and/or lateral lumbar interbody fusion is followed by percutaneous posterior fixation days later. This study examines the impact on outcomes when posterior augmentation was delayed due to unexpected medical issues following the first stage, anterolateral procedure.

METHODS

A retrospective review was conducted of all patients undergoing minimally invasive circumferential deformity corrections from 2006 to 2019. Patients in whom planned posterior fixation was postponed due to medical necessity or safety concerns were identified. Perioperative surgical metrics and radiographic parameters were collected.

RESULTS

Three of the six patients initially scheduled for circumferential fusion never underwent posterior augmentation due to symptomatic improvement (2.3, 5, and 10.7 years of follow-up). The other three underwent posterior fixation once medically optimized after an average interval of 4.7 months (range 3.2-7.8 months) due to persistent symptoms. It was also observed that the average coronal malalignment in the postoperative period was 5.1 cm in the group requiring further fixation and only 1.6 cm in the group which did not.

CONCLUSION

In select cases, the indirect decompression and stability conferred by minimally invasive anterolateral arthrodesis alone may afford adequate pain relief to delay or even avoid posterior fixation in patients with adult spinal deformity.

Minimally Invasive Approach for Degenerative Spondylolisthesis: Lateral Single-Position Surgery with Intraoperative Computed Tomography Navigation and Fluoroscopy: A Technical Note

OBJECTIVE

Degenerative spondylolisthesis (DS) is a prevalent condition that leads to low back pain and neurological symptoms. This technical note presents a novel surgical strategy for treating DS using lateral single-position surgery (SPS) in combination with intraoperative computed tomography navigation and fluoroscopy.

METHODS

Fifteen patients (5 males and 10 females, mean age 70.2 years) diagnosed with DS with a slip of 5 mm or more underwent lateral lumbar interbody fusion (LLIF) with percutaneous pedicle screw (PPS) fixation using this technique. The procedure involved slip reduction using an upside PPS and rod fixation, followed by LLIF performed in the same lateral position. The term "upside PPS" refers to a PPS that is inserted on the ceiling side of the patient's surgical field. Preoperative and postoperative radiographic assessments were conducted to evaluate the effectiveness of the lateral SPS.

RESULTS

The results demonstrated significant improvements in various parameters, including spondylolisthesis reduction, segmental lordosis, disc height, and spinal canal dimensions. The lateral-SPS procedure exhibited several advantages over traditional flip LLIF approaches for slip reduction. Additionally, the technique provided accurate intraoperative navigation guidance through computed tomography imaging, ensuring precise implant placement and slip reduction.

CONCLUSIONS

Combining LLIF and PPS fixation in a single procedure presents a precise, efficient approach for DS treatment, minimizing repositioning needs. This technique enables effective lumbar reconstruction, restoration of spinal stability, and improved patient outcomes. Although further investigation is warranted, lateral SPS surgery may hold promise as an innovative solution for managing DS by reducing surgical invasiveness and optimizing surgical efficiency.