Indirect Decompression Failure After Lateral Lumbar Interbody Fusion—Reported Failures and Predictive Factors: Systematic Review

Kırnaz, Sertaç; Navarro-Ramírez, Rodrigo; Gu, Jiaao; Wipplinger, Christoph; Hussain, Ibrahim; Adjei, Joshua; Kim, Eliana; Schmidt, Franziska Anna; Wong, Taylor; Hernandez, R. Nick; Härtl, Roger

doi:10.1177/2192568219876244

Cited by 33 publications

(17 citation statements)

References 32 publications

(94 reference statements)

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“…The number of operated levels, different fusion segments, and cage characteristics were also not the contributing factors to failure. These findings were consistent with previous literature [ 8 , 9 , 26 ].…”

Section: Discussionsupporting

confidence: 94%

“…In this study, we reported the rate of indirect decompression failure after applying our selection criteria to be as low as 6.8% which was relatively lower than those reported in previous studies [ 8 , 9 , 17 - 19 ]. All criteria were made of patient characteristics which all of them were nonmodifiable patient factors, so we believed that these factors would comprise a practical prerequisite for the procedure.…”

Section: Discussioncontrasting

confidence: 63%

“…To date, only a few studies with small subjects have used an algorithmic approach to select cases for this procedure [ 11 ]. A systematic review by Kirnaz et al [ 9 ] estimated the pooled incidence of indirect decompression failure following LLIF as 9%, but limited studies in the review had clear patient selection criteria, and most did not investigate the causes of failure.…”

Section: Introductionmentioning

confidence: 99%

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Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

et al. 2022

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Purpose: No consensus criteria have been established regarding ideal candidates for indirect decompression with lateral lumbar interbody fusion (LLIF), and contributing factors of indirect decompression failure were rarely reported. We aim to investigate the success rate of indirect decompression by LLIF with proposed selection criteria and identify risk factors associated with indirect decompression failure, defined as persistent pain requiring revision with direct decompression. Methods: Data from 191 patients undergoing LLIF were retrospectively reviewed. All the following criteria must be fulfilled: 1) dynamic clinical symptoms (pain relief in supine position), 2) presence of reducible disc height (recovered disc height in supine position), 3) no profound weakness and 4) no static stenosis. The success rate of indirect decompression with LLIF and results after at least 1-year of follow-up were collected. Preoperative, procedure-related, and postoperative factors were assessed for their relationship with failure. Results: Of 191 patients,13 patients (6.8%) required additional direct decompression due to persistent pain, giving a criteria success rate of 93.2%. Factors associated with indirect decompression failure included low bone mineral density (BMD) (T-score < 2.1), low reducible disc height (<13%), low postoperative disc height (<10 mm), high-grade cage subsidence, and use of plate fixation. Conclusion: We proposed patient selection criteria for indirect decompression with LLIF which had a satisfactory success rate and identified factors associated with the need for additional direct decompression. Our proposed criteria may assist selection of patients likely to achieve good results following indirect decompression with LLIF, and optimize selection based on risk factors of failure.

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Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

et al. 2022

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“…In a prospective randomized study [ 3 ], LLIF results in an increased foraminal area by 23% compared with 4.9% in MIS-TLIF on the approach side at three month follow-up. Kirnaz et al [ 35 ] recommended indirect decompression for patients who have symptomatic FS as long as we can confirm the source of the pain by eliciting radicular symptoms with a Kemp’s test. However, at present, there has been no research that looks at the efficacy of LLIF for patients only with radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

Predictors for second-stage posterior direct decompression after lateral lumbar interbody fusion: a review of five hundred fifty-seven patients in the past five years

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et al. 2022

International Orthopaedics (SICOT)

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Purpose To analyze the predictors for second-stage posterior direct decompression (PDD) after lateral lumbar interbody fusion (LLIF) procedure. Methods We studied patients who underwent LLIF for degenerative lumbar spinal stenosis in the last five years, from July 2016 to June 2021. All surgical levels were grouped according to Schizas’ central canal stenosis (CCS) classification, Pathria’s facet joint degeneration (FJD) classification, Bartynski’s lateral recess stenosis (LRS) classification, and Lee’s foraminal stenosis (FS) classification. Second-stage PDD rates of each subgroup and their annual change were analyzed. Evaluation of risk factors associated with PDD was investigated. Results A total of 901 segments from 557 patients were included. The overall PDD rate was 29.97%. An overall PDD rate of 75.21% for grade D CCS, 29.74% for grade C CCS, 41.67% for grade 3 FJD, 37.61% for grade 3 LRS, and 40.70% for grade 3 FS was shown. While there was a continuous decline in annual PDD rate in the past four years, the annual PDD rate for grade D remained at very high levels. Logistic regression analysis had shown grade D CCS as the utmost risk factor for PDD (OR = 17.77). And grade 3 LRS (OR = 4.63), grade 3 FS (OR = 2.42), grade C CCS (OR = 2.41), and grade 3 FJD (OR = 2.04) were also moderately correlated with PDD, which meant they only moderately increased the risk of PDD. Conclusion Extreme severe lumbar CCS (grade D) is the greatest determinant to perform the second-stage PDD procedure after LLIF.

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“…In a recent literature review, there was an overall incidence of indirect decompression failure of 9%. 6 Indirect decompression failure can be both related to patient factors (eg, concomitant central stenosis or lateral recess stenosis) and procedure factors such as cage dimensions or cage position. [7][8][9] To overcome this limitation, we modified the LLIF technique to include a minimally invasive tubular decompression (single-stage LLIF workflow [SSLLIF+]) in the same lateral position to treat concomitant pathology directly.…”

mentioning

confidence: 99%

Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series

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Hussain

et al. 2022

Operative Neurosurgery

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BACKGROUND:Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).OBJECTIVE:To report on the procedural steps and clinical outcomes of the SSLLIF+.METHODS:In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.RESULTS:A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.CONCLUSION:SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.

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Indirect Decompression Failure After Lateral Lumbar Interbody Fusion—Reported Failures and Predictive Factors: Systematic Review

Cited by 33 publications

References 32 publications

Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

Predictors for second-stage posterior direct decompression after lateral lumbar interbody fusion: a review of five hundred fifty-seven patients in the past five years

Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series

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