Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy

Abstract

This study aims to present our surgical technique of lateral lumbar interbody fusion (LLIF) without corpectomy for lumbar vertebral fracture (LVF) associated radiculopathy. This study includes three patients treated with LLIF (mean age of 77.3 years, Group L) and three patients treated with PLIF (mean age of 75.7 years, Group P) to compare the surgical outcomes. The cartilage on the fractured vertebrae was aggressively resected with attention to avoid injury to the ring apophysis. The central cavity of the fractured endplate was filled with a bone graft substitute made of hydroxyapatite and collagen composite, followed by interbody fusion achieved by utilizing of a cage with sufficient length spanning the bilateral edges of the fractured vertebra. PLIF was performed with a standard technique using two interbody cages, and vertebroplasty was combined in one patient. Comparing to PLIF, LLIF could be performed with less estimated blood loss in shorter surgical time. Local kyphotic angle improved in all cases of Group L immediately after the surgery, but correction loss was observed at the final examination. The lordotic angle was lost in Group P postoperatively. Arthrodesis was achieved in all the cases. The mean VAS score for leg pain was 85.3 mm in Group L and 82.0 mm in Group P at preoperation and decreased to 8.7 mm and 11.3 mm, respectively, at postoperation. LLIF is an effective surgical option that enables stabilization of the fractured vertebra and reduces radicular pain by indirect neural decompression.

Lateral Lumbar Interbody Fusion within Three-level for Patients with Neurological Symptoms due to Vertebral Fragility Fractures in the Lumbar Spine

“…To date, there have only been a few reports on the use of LLIF in patients with VFF. 14 , 15 ) Hence, the current knowledge on the effectiveness of LLIF for VFF remains insufficient. The present study provides a more comprehensive analysis of measuring fractured vertebral body height, bone fusion evaluation by CT scan, and detailed information on the perioperative period, which includes the duration of conservative treatment.…”

“…[11][12][13] Thus far, there have been few reports on whether LLIF provides adequate spinal correction and improves neurological symptoms in patients with lumbar spine VFF. 14,15) The criteria for suitable patient selection and optimal timing for LLIF in such patients remain not well understood. Thus, this study retrospectively examined the surgical outcomes of LLIF for lumbar spine VFF with neurological deficits and provided a surgical strategy for treating this difficult condition.…”