Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature

Abstract

Background: In the past decade, lateral lumbar interbody fusion (LLIF) has gained in popularity. A proposed advantage is the achievement of indirect neural decompression. However, evidence of the effectiveness of LLIF in neural decompression in lumbar degenerative conditions remains unclear. Questions/Purposes: We sought to extrapolate clinical and radiological results and consequently the potential benefits and limitations of LLIF in indirect neural decompression in degenerative lumbar diseases. Methods: We conducted a systematic review of the literature in English using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain were extracted, as were data on the following radiological measurements: disc height (DH), foraminal height (FH), foraminal area (FA), central canal area (CA). Results: In the 42 articles included, data on 2445 patients (3779 levels treated) with a mean follow-up of 14.8 ± 5.9 months were analyzed. Mean improvements in VAS back, VAS leg, and ODI scale scores were 4.1 ± 2.5, 3.9 ± 2.2, and 21.9 ± 7.2, respectively. Post-operative DH, FH, FA, and CA measurements increased by 68.6%, 21.9%, 37.7%, and 29.3%, respectively. Conclusion: Clinical results indicate LLIF as an efficient technique in indirect neural decompression. Analysis of radiological data demonstrates the effectiveness of symmetrical foraminal decompression. Data regarding indirect decompression of central canal and lateral recess are inconclusive and contradictory. Bony stenosis appears as an absolute contraindication. The role of facet joint degeneration is unclear. This systematic review provides a reference for surgeons to define the potential and limitations of LLIF in indirect neural elements decompression.Keywords lateral lumbar interbody fusion . indirect neural decompression . lumbar stenosis . outcomes . extreme lateral interbody fusion . lumbar degenerative diseases

Comparison of Oblique Lateral Interbody Fusion (OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) for Treatment of Lumbar Degeneration Disease

“…Unfortunately, the exact indications for indirect decompression remain inconclusive and contradictory. 38 Specifically, some patients were reported unsuitable for indirect decompression, such as those with calcified discs, severe facet hypertrophy, synovial cysts, severe central canal stenosis, uncontained disc herniations, and osteophytes arising from the posterior endplates. [38][39][40] This study has some limitations.…”

The Feasibility of 3D Intraoperative Navigation in Lateral Lumbar Interbody Fusion: Perioperative Outcomes, Accuracy of Cage Placement and Radiation Exposure

“…10,11 Furthermore, the ability to place a large interbody cage to restore disc height and achieve indirect central and foraminal decompression without direct visualization of the neural elements spares the morbidity and complication profile of the posterior approach. [12][13][14][15][16][17][18] However, due to the possibility of approach-related complications including lumbosacral plexus injury, intraoperative radiographic guidance and neuromonitoring are of paramount importance. [19][20][21] Although fluoroscopy has been the mainstay for intraoperative radiographic guidance during LLIF procedures, 3D intraoperative navigation (ION) is being increasingly considered as it may provide for potentially increased accuracy of interbody placement and decreased radiation exposure to operating room staff.…”

Circumferential Fusion Employing Transforaminal vs. Direct Lateral Lumbar Interbody Fusion—A Potential Impact on Implants Stability

“…To achieve substantial stability of the altered segment various types of interbody fusion were suggested, out of those the most frequently used are PLIF, TLIF, DLIF, OLIF, and ALIF ( 4 ). Despite a considerable number of relevant works published, no clear guidelines were worked out for the rational application of those techniques.…”

“…Even though TLIF is frequently supplemented by PLF to achieve circumferential fusion, those techniques are frequently opposed in relevant studies ( 3 ). DLIF using a lateral minimally invasive approach is getting more popular as an effective option to achieve indirect decompression and restoration of sagittal alignment ( 4 ). On the other hand, the evidence that the application of DLIF provides better outcomes than direct decompression with TLIF is insufficient especially if short fusion is required, therefore, no clear guidelines exist on the rational application of those techniques ( 5 – 8 ).…”