Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

Abstract

Objective: There is a lack of literature on indirect decompression in uniportal endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF). Our aim is to evaluate the dimensions of the spinal canal and contralateral foramen before and after EPTLIF.Methods: This is a retrospective study of patients who underwent EPTLIF in a tertiary spine centre over a 2-year period. The cross-sectional area of the spinal canal and the contralateral foramen at the level of fusion were measured on magnetic resonance imaging scan at 1-day postoperation and at the final follow-up. Patients were grouped according to the decompression performed as per the clinician’s judgement.Results: One hundred fifty-two levels of fusion were performed in 120 patients. There was a statistically significant clinical improvement in visual analogue scale and Oswestry Disability Index scores postoperation. The measurements of the spinal canal area were 106.0 mm<sup>2</sup>, 138.8 mm<sup>2</sup>, and 195.5 mm<sup>2</sup>; while contralateral foraminal area were 73.2 mm<sup>2</sup>, 104.4 mm<sup>2</sup>, and 120.7 mm<sup>2</sup> at preoperation, 1-day postoperation, and at the final follow-up, respectively (p < 0.001). For the subgroup analyses, spinal canal area measurements for the bilateral decompression cohort (n = 35) were 57.0 mm<sup>2</sup>, 123.9 mm<sup>2</sup>, and 191.8 mm<sup>2</sup>; for the ipsilateral decompression cohort (n = 42) were 89.3 mm<sup>2</sup>, 128.9 mm<sup>2</sup>, 183.3 mm<sup>2</sup>; and for the cohort without any decompression and only cage inserted (n = 75) were 138.3 mm<sup>2</sup>, 151.2 mm<sup>2</sup>, and 204.1 mm<sup>2</sup> (p < 0.001). Contralateral foraminal area measurements were 73.3 mm<sup>2</sup>, 106.4 mm<sup>2</sup> and 120.4 mm<sup>2</sup> in the bilateral decompression cohort; 69.5 mm<sup>2</sup>, 99.0 mm<sup>2</sup>, 116.9 mm<sup>2</sup> in the ipsilateral decompression cohort; and 75.1 mm<sup>2</sup>, 106.5 mm<sup>2</sup>, 122.9 mm<sup>2</sup> in the cohort without any decompression (p < 0.001).Conclusion: Indirect decompression of both the spinal canal and the contralateral foramen can be achieved via EPTLIF. Decompression on an asymptomatic contralateral side is not necessary.

Outcomes in Lumbar Fusion Patients Stratified by the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification System

“…However, no significant differences in patient-reported outcome measures (PROMs) were observed across the other CARDS classes in the univariable or multivariable analyses, leading the authors to conclude that while CARDS A patients appear to benefit from TLIF, no additional benefit of interbody placement exists in CARDS B or C patients [15]. Given that interbody placement can provide enhanced disc space restoration and indirect neuroforaminal decompression [15,22,23], the benefit of this approach among CARDS A patients is logical. Unsurprisingly, overall trends in the performance of interbody fusions are variable across CARDS groups in the current study and others given the heterogeneous nature of DLS.…”

Trends in degenerative lumbar spinal surgery during the early COVID-19 pandemic in Republic of Korea: A national study utilizing the national health insurance database

“…Even those who experienced spontaneous improvement might have benefitted from surgery (e.g., less pain, potentially better neurologic recovery, etc.). Consequently, it is possible that certain patients continued to suffer from pain and disability and were unable to return to their normal lives [ 14 , 34 – 36 ]. With applying surgical criteria strictly to decide the necessity of elective lumbar surgeries, essential elective surgeries could be performed.…”

Trends in Degenerative Lumbar Spinal Surgery During the Early COVID-19 Pandemic in Republic of Korea: A National Study Utilizing the National Health Insurance Database

“…Consequently, it is possible that certain patients continued to suffer from pain and disability and were unable to return to their normal lives. 13,[34][35][36] The current study showed that the regulation of the COVID-19 pandemic in ROK did not affect the total number of elective operations, and this lesson may be useful in planning policies about spine surgery and transitioning to the "new normal" era.…”