Perioperative Factors Influencing Postoperative Satisfaction After Lateral Access Surgery for Degenerative Lumbar Spondylolisthesis

Excessive Fluid in the Lumbar Facet Joint as a Predictor of Radiological Outcomes After Lateral Lumbar Interbody Fusion

Background Preoperative segmental instability maybe a predictor of postoperative outcomes when treated with lateral lumbar interbody fusion (LLIF). An abnormal collection of fluid within the facet joint has been described as a sign of segmental instability. The potential relationship between this radiological sign and its prognostic relevance for indirect decompression (ID) has not been investigated. Methods Clinical and radiologic results from patients undergoing LLIF in a single institution between 2007 and 2014 were evaluated retrospectively. Patients were divided into two groups: those presenting with excessive fluid (EF) in the facet joints on T2-MRI and those with a normal amount of facet fluid with less than 1mm, which were controls. Radiological parameters were foraminal height, disc height, Cobb angle, and lumbar lordosis. Results A total of 21 patients (43 operated levels) were evaluated pre- and postoperatively. Mean disc height, mean foraminal height, and coronal Cobb angles were statistically significantly improved after LLIF. Only the EF group showed significant improvement in radiological markers after ID; the mean disc height improved from 5.5±2 to 8.8±1mm (p=0.001), mean foraminal height improved from 16.88±3 to 20.53±3mm (p=0.002), and the mean Cobb angle improved from 27.7±16 to 14±13 (p=0.018). Conclusions Patients undergoing LLIF with the radiological findings of EF in the facet joints demonstrated significant improvement in radiological outcomes of ID. Further studies should validate these findings in larger data sets.

Degenerative Spondylolisthesis: A Narrative Review

Degenerative spondylolisthesis (DS) is a condition leading to the slippage of one vertebral body over the one below due to degenerative changes resulting in spinal stenosis and producing neurogenic claudication, with or without low back pain. DS prevalence is age and gender specific. Other risk factors mainly include a history of occupational driving, intense manual activity and sedentary work. Diagnosis for patients with DS include detailed history, physical examination and imaging through standing lateral radiographs and MRI. Most patients with symptomatic DS and absence of neurologic deficits should perform better with conservative treatment, whereas, patients with neurological symptoms, are more prone to undergo progressive functional deterioration without surgery. There is a lack of agreement on the best surgical management in patients with DS and symptomatic stenosis. There is a contradictory data that does not permit for a recommendation for or against the addition of fusion to decompression. There is also controversy on which fusion technique is best. Spinal minimally invasive surgery is a promising approach for DS promoting early recovery and enhanced quality of life by reducing skin incision, muscular damage and perioperative pain with significant improvements in clinical results and high satisfaction rates.

Degenerative Lumbar Stenosis Surgery: Predictive Factors of Clinical Outcome-Experience with 1001 Patients

BACKGROUND

Degenerative lumbar spinal stenosis (DLSS) carries a high risk of morbidity and represents a financial burden to society. A late diagnosis can lead to severe disability. Although lumbar decompressive surgery has been widely used worldwide, the proper preoperative factors to define the ideal candidates for decompression are missing.

METHODS

A total of 1001 patients who had undergone decompressive surgery from 2012 to 2019 for DLSS were screened for the presence of 9 clinical and radiological parameters. For all cases, the differences between the baseline and postoperative Oswestry disability index were calculated and the results categorized as 5 different classes (ranging from very poor outcomes to excellent outcomes) according to the specific scores. Generalized ordinal logistic regression was then used to analyze the significance of the 9 parameters (coded as dummy variables) in predicting the outcome as measured by Oswestry disability index improvement after surgery.

RESULTS

Of the 9 parameters, 8 were found to be significant predictors. The radiological grade of compression was the strongest, followed by polyneuropathy, obesity, symptom duration, gait autonomy, radicular deficits, American Society of Anesthesiologists score, and level of surgery. In contrast, previous back surgery was not predictive of the outcome.

CONCLUSIONS

Our findings have indicated that the ideal candidate for surgery will have the following preoperative characteristics: Schizas grade D, no signs of peripheral polyneuropathy, body mass index <30 kg/m², symptom duration of <2 years, gait autonomy <100 m, no radicular deficits, 1 level of stenosis, and an American Society of Anesthesiologists score of 1, 2, or 3.