Neural decompression in challenging cases: advantages and disadvantages

Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series

BACKGROUND

Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).

OBJECTIVE

To report on the procedural steps and clinical outcomes of the SSLLIF+.

METHODS

In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.

RESULTS

A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.

CONCLUSION

SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.

Navigation-Guided Single-Position Lumbar Lateral Interbody Fusion and Minimally Invasive Tubular Decompression: 2-Dimensional Operative Video

Lateral lumbar interbody fusion (LLIF) has several advantages over the other fusion techniques; by allowing the placement of a larger implant, LLIF results in better indirect decompression and increased disk height, foraminal height, and cross-sectional area of the dural sac.1,2 However, one of the primary drawbacks of the LLIF has been the need for repositioning to perform posterior stabilization. Furthermore, patients with severe central and lateral recess stenosis were found to be prone to indirect decompression failure after the LLIF procedure.3 In this video, we demonstrate a step-by-step technique for intraoperative navigation-guided lateral single-position LLIF with pedicle screw instrumentation and minimally invasive tubular decompression. We present a case of a 64-year-old female patient with a history of low back pain which radiates to the buttocks and posterior legs to her knees. The patient was treated by a single-position LLIF with posterior pedicle screw fixation using a portable intraoperative computed tomography scanner (Airo, Brainlab AG), combined with 3-dimensional computer navigation and minimally invasive tubular decompression at the L3-4 level. The patient was discharged at postoperative day 1 with excellent long-term clinical outcomes. Patient consent was obtained before performing the procedure. The participants and any identifiable individuals consented to publication of his/her image.