Decompression of Lumbar Central Spinal Canal Stenosis Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Objective: The objective of this study was to evaluate radiologic changes in central spinal canal dimensions following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with placement of a static or an expandable interbody device.Summary of Background Data: MIS-TLIF is used to treat lumbar degenerative diseases and low-grade spondylolisthesis. MIS-TLIF enables direct and indirect decompression of lumbar spinal stenosis, with patients experiencing relief from radiculopathy and neurogenic claudication. However, the effects of MIS-TLIF on the central spinal canal are not well-characterized. Materials and Methods:We identified patients who underwent MIS-TLIF for degenerative lumbar spondylolisthesis and concurrent moderate to severe spinal stenosis. We selected patients who had both preoperative and postoperative magnetic resonance imaging (MRI) and upright lateral radiographs of the lumbar spine. Measurements on axial T2-weighted MRI scans include anteroposterior and transverse dimensions of the dural sac and osseous spinal canal. Measurements on radiographs include disk height, neural foraminal height, segmental lordosis, and spondylolisthesis.We made pairwise comparisons between each of the central canal dimensions and lumbar sagittal segmental radiologic outcome measures relative to their corresponding preoperative values. Correlation coefficients were used to quantify the association between changes in lumbar sagittal segmental parameters relative to changes in radiologic outcomes of central canal dimensions. Statistical analysis was performed for "all patients" and further stratified by interbody device subgroups (static and expandable).Results: Fifty-one patients (age 60.4 y, 68.6% female) who underwent MIS-TLIF at 55 levels (65.5% at L4-L5) were included in the analysis. Expandable interbody devices were used in 45/55 (81.8%) levels. Mean duration from surgery to postoperative MRI scan was 16.5 months (SD 11.9). MIS-TLIF was associated with significant improvements in dural sac dimensions (anteroposterior +0.31 cm, transverse +0.38 cm) and osseous spinal canal dimensions (anteroposterior +0.16 cm, transverse +0.32 cm). Sagittal lumbar segmental parameters of disk height (+0.56 cm), neural foraminal height (+0.35 cm), segmental lordosis (+4.26 degrees), and spondylolisthesis (−7.5%) were also improved following MIS-TLIF. We did not find meaningful associations between the changes in central canal dimensions relative to the corresponding changes in any of the sagittal lumbar segmental parameters. Stratified analysis by interbody device type (static and expandable) revealed similar within-group changes as in the overall cohort and minimal between-group differences.Conclusions: MIS-TLIF is associated with radiologic decompression of neural foraminal and central spinal canal stenosis. The mechanism for neural foraminal and central canal decompression is likely driven by a combination of direct and indirect corrective techniques.

Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review

“…Ultimately, nine studies were included in this review. 4,[11][12][13][14][15][16][17][18] The articles were assessed for risk of bias, and of the nine articles included, two cadaveric studies were exempted from most questions, and marked as not applicable. Of the remaining seven, five were assessed to be of good quality.…”

“…They are also associated with less disruptive muscle dissection and reduced removal of laminae and facet joints. 4 Several randomized prospective trials have demonstrated comparable clinical outcomes between ESS and MISS. However, there are limited radiographic surveillance data demonstrating the extent of bony decompression compared with that of the traditional microsurgical technique.…”

“…3 This is a multifactorial disease thought to occur due to thickening of the ligamentum flavum, disk degeneration, disk herniation, facet joint hypertrophy, and damage due to osteophyte formation, causing neuroforaminal and central spinal canal stenosis affecting the neurovascular structures of the region. 4 As the initial therapeutic approach, conservative treatments, including physical therapy, nerve block procedures, and pharmacologic therapies, are generally offered to patients. However, surgery represents an effective treatment approach as it provides patients satisfactory longterm relief.…”

Application and thinking of minimally invasive transforaminal lumbar interbody fusion in degenerative lumbar diseases

“…During the operation, the traction of the nerve root and dural sac are avoided, the risk of injury is reduced, and the risk of dural sac tear and nerve root traction injury are reduced. PLIF is suitable for the treatment of degenerative lumbar diseases, discogenic low back pain, recurrent intervertebral disc herniation, degenerative spinal canal stenosis, grades I and II spondylolisthesis, isthmic lumbar spondylolisthesis, degenerative scoliosis, intervertebral pseudo-joint formation, and unilateral intervertebral disc protrusion, but it is not suitable for the treatment of severe osteoporosis in patients with severe peridural fibrosis and a history of posterior extensive laminectomy decompression (28)(29)(30). Lumbar interbody fusion includes common PLIF, transforaminal lumbar interbody fusion (TLIF), oblique lateral interbody fusion (OLIF) and anterior lumbar interbody fusion (ALIF), while MIS-TLIF is accepted by most clinicians because of its small trauma and low risk of disability.…”

Cirugía de mínima invasión. Fusión intersomática lumbar transforaminal. Argumento de posición grupo de estudio cirugía vertebral Latinoamérica

“…6,7 In the short term, we can mention results that show that an adequate discectomy and placement of the intersomatic cage translates into sufficient indirect decompression for the nerve roots, in addition, as an alternative, a direct decompression can be performed unilaterally «Over-the-top» with the help of a tubular retractor 8 (Figure 1), achieving decompression of the central canal and a foraminal level, which we can corroborate in radiographic and magnetic resonance studies. 9,10 As it is a technique of less than 2 decades of development, at the moment, the literature reports follow-up results ranging from 1 to 5 years post-surgery. In some studies with similar results comparing with y descompresiones desde T12 a S1 con impacto positivo en la recuperación postquirúrgica a corto y mediano plazo comparado con técnicas abiertas.…”