Contraindication of Minimally Invasive Lateral Interbody Fusion for Percutaneous Reduction of Degenerative Spondylolisthesis: A New Radiographic Indicator of Bony Lateral Recess Stenosis Using I Line

Abstract

This study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS). Overview of Literature: No previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS. Methods: A retrospective review of 185 consecutive patients, who underwent 1-or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the "recovery" or "no-recovery" group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0-3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups' characteristics were compared. Results: There were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; p=0.0233). Conclusions: In DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.

Reduction Capacity and Factors Affecting Slip Reduction Using Cortical Bone Trajectory Technique in Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

“…Because instrumentation failure is the result of a complex combination of factors, the reduction maneuver itself may go unrecognized as a possible cause. This study showed a comparable or superior slip reduction rate to those reported in previous studies 3,[18][19][20][21][22][23][24] . (Table 3) One reason for the favorable results may be that the preoperative vertebral slip, which was identified as a factor contributing to the slip reduction rate in this study, was not as large as in other Spine Surgery and Related Research J-STAGE Advance Publication (February 10, 2022) Ⓒ The Japanese Society for Spine Surgery and Related Research.…”

Hybrid surgery of percutaneous transforaminal endoscopic surgery (PTES) combined with OLIF and anterolateral screws rod fixation for treatment of multi-level lumbar degenerative diseases with intervertebral instability

“…To some extent, these can relieve the patient's symptoms in OLIF [23]. However, sometimes OLIF alone had no improvement of neurologic symptoms due to the inadequate decompression such as extreme severe lumbar canal stenosis and bony lateral recess stenosis [10,12,[24][25][26][27]. When the segment is too rigid to be restored, it is difficult to obtain a greater postoperative disc height and more indirect decompression effect [28].…”

Percutaneous transforaminal endoscopic surgery combined with mini-incision OLIF and anterolateral screws rod fixation vs. MIS-TLIF for surgical treatment of single-level lumbar spondylolisthesis

“…The segment is too rigid to be restored, which indicates that it is difficult to obtain a greater postoperative disc height and more indirect decompression effect (24). Some studies showed that bony lateral recess stenosis is an independent predictor for failure to achieve adequate spinal decompression via indirect decompression with lateral lumbar interbody fusion (25)(26)(27). Additionally, the free herniated disc migrating into spinal canal or head, or tail of the involved segment could not be treated by indirect decompression of OLIF.…”