Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

Abstract

Study DesignA single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis.PurposeThis study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis.Overview of LiteratureAlthough microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain.MethodsA total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up.ResultsThe average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports.ConclusionsAlthough microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.

Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients

“…[ 34 35 36 37 ] FE-PSLD can be argued to be superior to conventional surgery with several considerations: (1) Minimal blood loss and damaged anatomical structure, leading to less spinal instability complication and the need of future spinal fusion; (2) Ability to decompress single to multiple levels of LSS concurrently with single skin incision using uniportal access; and (3) Ability to decompress central and lateral recess LSS and excised herniated disc concomitantly with stenoscope by translaminar approach. [ 34 38 39 ] The feasibility of PSLD as effective management to replaced conventional open surgery for lumbar stenosis was also proven by Lim et al ., study on LSS patients which shown a significant increase of spinal canal volume, less soft-tissue damage by MRI, less hospital stay, and pain improvement with a mean score of 4. [ 34 35 ]…”

Radiologic Assessment of Interbody Fusion

“…After 2013, CT scans were most often used (36% of articles), but both CR (32%) and dynamic radiographs (32%) remained popular. Dynamic CT (experimentally) 17 and magnetic resonance imaging (MRI) (as standard practice) 18 were used once for fusion assessment. None of the included articles used ultrasound, positron emission tomography or single-photon emission CT.…”

Transforaminal Endoscopic Lumbar Lateral Recess Decompression for Octogenarian Patients

“…If extensive conservative therapies fail to relieve the radicular pain, a decisive surgical treatment should be considered. Open laminectomy with or without fusion has been regarded as the standard surgical technique for LRS [6,7]. Nevertheless, opting for such open surgery under general anesthesia may cause considerable perioperative morbidity for elderly patients with medical problems.…”