Degenerative lumbar spine disease (DLSD) is a heterogenous group of conditions that can significantly affect patients’ quality of life. Lateral lumbar interbody fusion (LLIF) is one of the treatment modalities for DLSD that has been increasing in popularity over the past decade. The treatment of DLSD should be individualized based on patients’ symptoms and characteristics to maximize outcomes. Methods: Literature review, invited review. Results: In this article, we will (1) review the use of the LLIF technique in the treatment of degenerative lumbar spine disease, (2) review the current concepts of LLIF, and (3) explore the evidence to date that will allow the reader to maximize the benefits of this technique. Conclusions: LLIF is an alternative for the treatment of degenerative pathologies of the lumbar spine via indirect decompression.
Background: There is significant variability in clinically important improvement (CII) criteria for spinal surgery that suggest population-and diagnosis-specific thresholds are required to determine surgical success using patient-reported outcome measures (PROMs). This study establishes surgical CII thresholds for 4 common lumbar degenerative spinal diagnoses using accepted anchor-based methodology and commonly used PROMs. Methods: CII analysis was conducted using baseline and 1-year data from participants in the Canadian Spine Outcomes and Research Network (CSORN) registry who underwent surgery for lumbar spinal stenosis (LSS), degenerative spondylolisthesis (DS), disc herniation (DH) or degenerative disc (DD) from 2015 to 2018. One-year CII thresholds were determined for the Oswestry Disability Index (ODI), and back and leg Numeric Pain Rating Scales (NPRS). At 1 year, patients reported whether they were much better, better, the same, worse or much worse compared with before their surgery. This was used as the anchor (improved: ≥ "better" v. not improved: ≤ "same") to determine CII thresholds for absolute change and percentage change for PROMs using a receiver operating characteristic (ROC) curve approach, with maximization of the Youden index as primary criterion. Correct classification rates were determined. Results: There were 856 participants with LSS (39.1% female, mean age 65.8 yr), 591 with DS (64.1% female, mean age 65.8 yr), 520 with DH (47.5% female, mean age 46.8 yr) and 185 with DD (43.8% female, mean age 50.9 yr). CII for ODI change ranged from -10.0 (DD) to -16.9 (DH). CII for back and leg NPRS change was -2 to -3 for each group. CII for percentage change varied by PROM and pathology group, ranging from -11.1% (ODI for DD) to -50.0% (leg NPRS for DH). Correct classification rates for all CII thresholds ranged from 72.1% to 89.4%. Conclusion: This work quantifies Canadian CII thresholds for the ODI and back and leg NPRS for 4 common lumbar spinal surgery cohorts, with high classification accuracy. Our results suggest that use of generic CII across different diagnoses in spine surgery is not advised. This study establishes the first comprehensive set of responder criteria in Canada for broader application and specificity in clinical and research settings and for surgical prognostic work.
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