Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis

Kim, Moon-Chan; Park, Jeong-Uk; Kim, Woochul; Lee, Hong-Seok; Chung, Hungtae; Kim, Moo-Won; Chung, Nam-Su

doi:10.1007/s00586-014-3192-3

Cited by 27 publications

(10 citation statements)

References 19 publications

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“…Based on this concept, the minimally invasive treatment of DLSS is applied. Many scholars have reported that MISTLIF through bilateral decompression via unilateral approach has achieved good results in the treatment of DLSS [14][15][16]. OLIF is a minimally invasive anterior retroperitoneal approach surgery, which has been very popular in recent years.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Oblique Lateral Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Stenosis: An Age-, Sex-, and segment-matched Cohort Study

Wang

Liu

Hou

et al. 2022

Preprint

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Objectives: To compare outcomes after oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) with bilateral decompression via unilateral approach for treating mild to moderate symptomatic degenerative lumbar spinal stenosis (DLSS).Methods: We retrospectively compared patients who underwent single-level (L4/5) OLIF with an age-, sex-, and segment-matched MISTLIF with bilateral decompression via unilateral approach cohort. Perioperative data were collected for the operative time, intraoperative blood loss, drainage in the first postoperative day, postoperative hospital stay, cost, intraoperative fluoroscopy, and complications. Lumbar radiographs were measured for changes in posterior intervertebral space height (PISH), intervertebral space foramen height (IFH), intervertebral foramen area (IFA), and area of the spinal canal (ASC). Clinical and psychological outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and hospital anxiety and depression scale (HADS).Results: 35 OLIF patients were compared with 35 MISTLIF patients in L4/5 DLSS. The OLIF group had shorter bedtime, postoperative hospital stays, less intraoperative and postoperative blood loss (all P<0.05), but had more times of intraoperative fluoroscopy, longer operative time, and higher cost (all P<0.05). The complication rates were equivalent (OLIF vs MISTLIF: 22.86% vs 17.14%). PISH (11.94±1.78mm vs 9.42±1.94mm, P<0.05), IFH (23.87±3.05mm vs 21.41±2.95mm, P<0.05), and IFA (212.14±51.82mm2 vs 177.07±51.73mm2, P<0.05) after surgery were significantly increased in the OLIF group. The ASC was increased significantly after the operation in both groups, but the ASC in the MISTLIF group was increased significantly more than that in the OLIF group (450.04±66.66mm2 vs 171.41±58.55mm2, P<0.05). The lumbar VAS scores at 1 month (1.89±0.87 vs 2.34±0.84, P=0.028) and 6 months (1.23±0.97 vs 1.80±0.99, P=0.018) after operation in the OLIF group were significantly lower. There were no significant differences in lower extremity VAS and ODI scores between the two groups. Compared with MISTLIF group, HADS scores on postoperative day 3 (2.91±1.46 vs 4.89±1.78, P<0.05) and prior to hospital discharge (PTD) (2.54±1.38 vs 3.80±1.78, P=0.002) in the OLIF group were decreased significantly. Conclusions: OLIF showed more advantages of less surgical invasion, lower incidence of postoperative low back pain, faster postoperative recovery, and less anxiety compared with MISTLIF. Regardless of cost, OLIF seems to be a better option to treat mild to moderate symptomatic DLSS.

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Section: Discussionmentioning

confidence: 99%

Comparison between Oblique Lateral Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Stenosis: An Age-, Sex-, and segment-matched Cohort Study

Wang

Liu

Hou

et al. 2022

Preprint

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“…11 Kim et al. 12 reported that unilateral MIS-TLIF can achieve indirect decompression of the contralateral foramen by increasing its height, width, and area. However, cases of contralateral radiculopathy following unilateral TLIF are still being reported.…”

Section: Discussionmentioning

confidence: 99%

Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention

Chen

Wang

et al. 2021

J Int Med Res

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Background Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage can provide circumferential fusion and biomechanical stability. However, the causes and prevention of contralateral radiculopathy following unilateral TLIF remain unclear. Methods In total, 190 patients who underwent unilateral TLIF from January 2017 to January 2019 were retrospectively reviewed. Radiological parameters including lumbar lordosis, segmental angle, anterior disc height, posterior disc height (PDH), foraminal height (FH), foraminal width, and foraminal area (FA) were measured preoperatively and postoperatively. Preoperative and postoperative visual analog scale scores were also recorded. Results The incidence of contralateral radiculopathy after unilateral TLIF was 5.3% (10/190). The most common cause was contralateral foraminal stenosis. Unilateral TLIF could increase the lumbar lordosis, segmental angle, and anterior disc height but decrease the PDH, FA, and FH in patients with symptomatic contralateral radiculopathy. The intervertebral cage should be placed to cover the epiphyseal ring and cortical compact bone of the midline, and the disc height can be increased to enlarge the contralateral foramen. Conclusion The most common cause of contralateral radiculopathy is contralateral foraminal stenosis. Careful preoperative planning is necessary to achieve satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA, and FH, resulting in contralateral radiculopathy.

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“…Iwata et al [ 7 ] investigated the mechanism of this effect by detailed radiographic measurements on the contralateral intervertebral foramen (IVF); however, his study involved patients with spondylolisthesis and neglected the extra impact of intravertebral reduction on IVF morphology in the presence of spondylolisthesis. Similarly, Kim et al [ 8 ] documented that the morphological parameters of contralateral IVF increased significantly after unilateral TLIF and that these changes might contribute to indirect decompression on the contralateral side; however, this study overlooked the effects of different cage location within the intervertebral disc space (IVS).…”

Section: Introductionmentioning

confidence: 91%

Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion

et al. 2019

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BackgroundThis study was performed to investigate the morphological changes of contralateral intervertebral foramen (IVF) based on computed tomography images of patients with lumbar spinal stenosis after unilateral transforaminal lumbar interbody fusion (TLIF) and to compare the influence of different orientation of cage insertion on these changes.MethodsThis is a retrospective cohort study. Sixty-nine patients with lumbar spinal stenosis who had undergone single-level unilateral TLIF were retrospectively analyzed. The patients were divided into two groups according to the cage insertion orientation: the oblique group (o-group, 39 cases) and the transverse group (t-group, 30 cases). The morphological parameters of contralateral IVF were measured before and 6 months after the operation. Changes in these parameters were compared and analyzed between the two groups. The 6-month clinical outcomes of the two groups were also collected and analyzed.ResultsThere was a significant difference in the rate of increase in the segmental angle (p < 0.01) between the two groups, the mean value of segmental angle increased by an average of 29.08% ± 14.93% in the o-group and 48.63% ± 12.01% in the t-group. Overall, the posterior disc height had a significant positive correlation with the foraminal height and area. In the o-group, however, an increase in the segmental angle resulted in a decrease in the foraminal area. No significant difference in clinical outcomes was found between the two groups.ConclusionsCompared with oblique cage insertion, transverse cage insertion could achieve greater restoration of segmental lumbar lordosis without decreasing contralateral foraminal dimensions.

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Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis

Abstract: Quantitative and qualitative parameters of the central canal and contralateral neural foramen increased significantly after unilateral-approach MITLIF.

Cited by 27 publications

References 19 publications

Comparison between Oblique Lateral Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Stenosis: An Age-, Sex-, and segment-matched Cohort Study

Comparison between Oblique Lateral Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Stenosis: An Age-, Sex-, and segment-matched Cohort Study

Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention

Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion

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