Bony Lateral Recess Stenosis and Other Radiographic Predictors of Failed Indirect Decompression via Extreme Lateral Interbody Fusion: Multi-Institutional Analysis of 101 Consecutive Spinal Levels

Wang, Timothy Y.; Nayar, Gautam; Brown, Christopher R.; Pimenta, Luiz; Karikari, Isaac O.; Isaacs, Robert E.

doi:10.1016/j.wneu.2017.07.045

Cited by 53 publications

(84 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Wang et al demonstrated that presence of bony lateral recess stenosis on preoperative imaging was a predictor for unsuccessful indirect decompression by XLIF in a study in which 9 of 16 patients with radiographic bony stenosis required revision surgery for persistent symptoms. 12 Similarly, another study demonstrated bony lateral recess stenosis to be the reason for unplanned second-stage direct decompressive procedure after XLIF in 3 out of the 11 cases. 13 The algorithm developed by Gabel et al to select patients best suited for indirect decompression from XLIF included absence of bony lateral recess stenosis as one of the predictors for successful decompression in their series of 28 patients.…”

Section: Discussionmentioning

confidence: 93%

See 1 more Smart Citation

Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression

Lim

Daly

Brown

et al. 2018

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Prospective cohort study. Objectives: Evidence on predicting the success of indirect decompression via extreme lateral interbody fusion (XLIF) is scarce. The authors investigated if patients who could achieve a pain-free position preoperatively would derive clinical benefit from XLIF without direct decompression. Methods: Data from 50 consecutive patients who underwent XLIF with and without direct decompression by a single surgeon from January 2014 to August 2017 was collected. Primary outcome is the rate of failure of patients who underwent XLIF without direct decompression, characterized by persistence of pain postoperatively that required reoperations within 6 months postoperatively. Secondary outcomes are clinical outcomes and patient-reported quality of life outcome data, including visual analogue scale for leg (VASL) and back (VASB) pain, Oswetry Disability Index (ODI), and Physical Component Score (PCS) and Mental Component Score (MCS) of SF-12, for up to 2 years postoperatively. Results: One patient with preoperative dynamic posture-related pain who underwent XLIF without direct decompression subsequently had a reoperation due to persisting pain. Statistically significant improvement was achieved across all patient reported outcomes ( P < .05): improvement of 68% for VASL, 61% for VASB, 50% for ODI, 33% for PCS, and 11% for MCS of SF-12 at last follow-up. Six patients had thigh symptoms that resolved. Conclusion: The simple clinical criterion based on postural pain status preoperatively may help clinicians in patient selection for indirect decompression of XLIF without the need for direct decompression. Further studies with larger cohorts are warranted to establish the validity of the algorithm.

show abstract

Section: Discussionmentioning

confidence: 93%

“…The studies that exist generally rely on various radiological factors, such as locked facets, severe central canal stenosis, or osteoporosis, as predictors of indirect decompression failure. 8 –13…”

Section: Introductionmentioning

confidence: 99%

Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression

Lim

Daly

Brown

et al. 2018

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…The clinical indications for posterior decompression after LLIF were inconsistent. There have been studies which claimed that factors likely to cause failure of indirect decompression include cage subsidence, low bone mineral density, severe central canal stenosis, ligamentum flavum hypertrophy, and osteophytes in the lateral recess and foraminal canal [11,14,[18][19][20][21][22]. Among them, severe central canal stenosis might be the major risk factor.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Zhang

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lateral lumbar interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas' classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P-values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

show abstract

“…Indirect decompression via LLIF has also been shown to be effective, 12 but indirect decompression is less effective for certain types of stenosis. Wang et al 13 found that bone lateral recess stenosis was a risk factor for unsuccessful indirect decompression with LLIF. It is unclear what specific criteria were used by the participating surgeons to exclude the option of MIS direct and/or indirect decompression, but the necessity for open decompression was the most prominent differentiating selection factor.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting approach selection for minimally invasive versus open surgery in the treatment of adult spinal deformity: analysis of a prospective, nonrandomized multicenter study

Park

Than

Mummaneni

et al. 2020

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVESurgical decision-making and planning is a key factor in optimizing outcomes in adult spinal deformity (ASD). Minimally invasive spinal (MIS) strategies for ASD have been increasingly used as an option to decrease postoperative morbidity. This study analyzes factors involved in the selection of either a traditional open approach or a minimally invasive approach to treat ASD in a prospective, nonrandomized multicenter trial. All centers had at least 5 years of experience in minimally invasive techniques for ASD.METHODSThe study enrolled 268 patients, of whom 120 underwent open surgery and 148 underwent MIS surgery. Inclusion criteria included age ≥ 18 years, and at least one of the following criteria: coronal curve (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, or thoracic kyphosis (TK) > 60°. Surgical approach selection was made at the discretion of the operating surgeon. Preoperative significant differences were included in a multivariate logistic regression analysis to determine odds ratios (ORs) for approach selection.RESULTSSignificant preoperative differences (p < 0.05) between open and MIS groups were noted for age (61.9 vs 66.7 years), numerical rating scale (NRS) back pain score (7.8 vs 7), CC (36° vs 26.1°), PT (26.4° vs 23°), T1 pelvic angle (TPA; 25.8° vs 21.7°), and pelvic incidence–lumbar lordosis (PI-LL; 19.6° vs 14.9°). No significant differences in BMI (29 vs 28.5 kg/m2), NRS leg pain score (5.2 vs 5.7), Oswestry Disability Index (48.4 vs 47.2), Scoliosis Research Society 22-item questionnaire score (2.7 vs 2.8), PI (58.3° vs 57.1°), LL (38.9° vs 42.3°), or SVA (73.8 mm vs 60.3 mm) were found. Multivariate analysis found that age (OR 1.05, p = 0.002), VAS back pain score (OR 1.21, p = 0.016), CC (OR 1.03, p < 0.001), decompression (OR 4.35, p < 0.001), and TPA (OR 1.09, p = 0.023) were significant factors in approach selection.CONCLUSIONSIncreasing age was the primary driver for selecting MIS surgery. Conversely, increasingly severe deformities and the need for open decompression were the main factors influencing the selection of traditional open surgery. As experience with MIS surgery continues to accumulate, future longitudinal evaluation will reveal if more experience, use of specialized treatment algorithms, refinement of techniques, and technology will expand surgeon adoption of MIS techniques for adult spinal deformity.

show abstract

Bony Lateral Recess Stenosis and Other Radiographic Predictors of Failed Indirect Decompression via Extreme Lateral Interbody Fusion: Multi-Institutional Analysis of 101 Consecutive Spinal Levels

Cited by 53 publications

References 26 publications

Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression

Dynamic Posture-Related Preoperative Pain as a Single Clinical Criterion in Patient Selection for Extreme Lateral Interbody Fusion Without Direct Decompression

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Factors affecting approach selection for minimally invasive versus open surgery in the treatment of adult spinal deformity: analysis of a prospective, nonrandomized multicenter study

Contact Info

Product

Resources

About