Extreme lateral interbody fusion relieves symptoms of spinal stenosis and low-grade spondylolisthesis by indirect decompression in complex patients

Abstract

Spinal stenosis and low-grade spondylolisthesis produce symptoms of neural compression that can be treated with extreme lateral lumbar interbody fusion (XLIF) via indirect decompression. This study aimed to investigate whether the restoration of disc dimensions would relieve symptoms of radiculopathy, claudication and back pain. In this retrospective study, patients undergoing XLIF surgery for relief of radicular symptoms or degenerative disc disease were included. Radiologically proven changes were used to assess the modes of degeneration. Objective measures such as the Visual Analogue Scale (VAS) for back and legs and the Oswestry Disability Index (ODI) were used. Complications were collated post-operatively from clinical notes and outpatient appointments. Twenty-three consecutive patients were included, of whom 91% had spinal stenosis. The cohort presented with multiple comorbidities and 35% of the cohort had undergone previous lumbar surgery. There was a 61% improvement of coronal Cobb angle and an 11% correction of the lordosis sustained 1year after surgery. Clinical outcomes at 1year showed 39%, 50% and 60% improvements in the ODI, back and leg VAS scores respectively. 48% of patients had reduced sensation related to lumbosacral plexus manipulation and one retroperitoneal haematoma was conservatively managed. Minimally invasive spinal (MIS) XLIF resulted in effective restoration of disc dimensions via indirect decompression, providing good relief of clinical symptoms evidenced by significant improvement in clinical outcome scores. XLIF corrected scoliosis and improved lumbar lordosis significantly. Several plexopathies did not hinder long-term recovery. XLIF is highly suited to treating complex patients with multiple comorbidities and degenerative disease.

Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results

“…The advantages of this technique include: (1) the indirect decompression of the neural elements, leaving the anterior and posterior longitudinal ligaments intact, (2) the restoration of the sagittal and coronal alignment of the spine, (3) a lower subsidence rate because of the implant of larger cages and (4) no damage caused to the paravertebral muscles compared to the conventional posterior arthrodesis and direct decompression techniques [2][3][4][5][6][7][8][9].…”

“…Compared to traditional posterior techniques, this approach is also advantageous in revision surgery cases as it allows to reach the vertebral bodies avoiding the scar tissue from previous interventions [3,4,10,11].…”

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

“…This procedure has been successfully used for obtaining effective reduction and favorable alignment through a minimally disruptive approach and indirect decompression of the spinal canal and intervertebral foramen. 2,21,25 A minimally invasive LLIF approach has been reported to reduce postoperative pain, tissue trauma, and operative and recovery times, thereby resulting in shorter hospital stays and brisker overall symptom improvement compared with traditional approaches. 22,25 Neurological complications associated with lateral approaches are frequently discussed in the literature.…”

“…2,21,25 A minimally invasive LLIF approach has been reported to reduce postoperative pain, tissue trauma, and operative and recovery times, thereby resulting in shorter hospital stays and brisker overall symptom improvement compared with traditional approaches. 22,25 Neurological complications associated with lateral approaches are frequently discussed in the literature. 5,18 Previous anatomical and radiographic evaluations have identified that the lumbar plexus migrates dorsally to ventrally from L2-3 as the lumbosacral plexus descends caudally to the L4-5 and L5-S1 levels.…”

“…19 Because of its ability to provide indirect decompression without disrupting the posterior elements, segmental stability, and lordosis restoration, the transpsoas LLIF technique has been proposed as a treatment option for DS at L4-5. 1,11,15,25,27 However, concerns exist about the rate of neurological complications associated with the lateral approach. 5,10,14,24 Furthermore, these complications are most conspicuous at the L4-5 level due to the anatomical arrangement of the lumbar plexus with narrower safe working zones more inferiorly in the lower lumbar spine.…”