The Evaluation of Indirect Neural Decompression After Lateral Lumbar Interbody Fusion Using Intraoperative Computed Tomography Myelogram

Hayama, Sachio; Nakano, Atsushi; Nakaya, Yoshiharu; Baba, Ichiro; Fujiwara, Keiichi; Fujishiro, Takashi; Yano, Toma; Usami, Yoshitada; Kino, Keiichiro; Obo, Takuya; Neo, Masashi

doi:10.1016/j.wneu.2018.08.146

Cited by 20 publications

(22 citation statements)

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“…In their study, two out of 28 patients required reoperation after lumbar decompression, but they did not include the revision surgery as a risk factor for insufficient indirect decompression [18]. Similar to our study, Hayama et al [18] also found that the thecal sac was markedly enlarged after LLIF and that the rate of expansion was good enough to match those recorded in reports of primary surgeries. In addition, they found few perioperative complications similar to those observed in primary surgeries using LLIF, and they noted that the accompanying symptoms were only transient, similar to those observed in our study.…”

Section: A B C D E Fsupporting

confidence: 81%

“…However, only few reports have focused on indirect decompression adopted for revision cases, and the clinical outcomes and complications of this operation were unclear. For example, Hayama et al [18] investigated the results of indirect decompressions using intraoperative computed tomography after LLIF and analyzed the risk factors of insufficient indirect decompression resulting in unnecessary direct decompressions. In their study, two out of 28 patients required reoperation after lumbar decompression, but they did not include the revision surgery as a risk factor for insufficient indirect decompression [18].…”

Section: A B C D E Fmentioning

confidence: 99%

“…For example, Hayama et al [18] investigated the results of indirect decompressions using intraoperative computed tomography after LLIF and analyzed the risk factors of insufficient indirect decompression resulting in unnecessary direct decompressions. In their study, two out of 28 patients required reoperation after lumbar decompression, but they did not include the revision surgery as a risk factor for insufficient indirect decompression [18]. Similar to our study, Hayama et al [18] also found that the thecal sac was markedly enlarged after LLIF and that the rate of expansion was good enough to match those recorded in reports of primary surgeries.…”

Section: A B C D E Fmentioning

confidence: 99%

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Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery

et al. 2020

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Study Design: Retrospective comparative study.Purpose: We compared clinical and radiographical outcomes after lumbar decompression revision surgery for restenosis by lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF).Overview of Literature: Indirect lumbar decompression with LLIF was used to treat degenerative lumbar diseases requiring neural decompression. However, only a few studies have focused on the effectiveness of this technique for restenosis after lumbar decompression.Methods: We retrospectively investigated 52 cases involving lumbar interbody fusions for restenosis with spondylolisthesis after lumbar decompressions; these cases consisted of 15 patients who underwent indirect decompression with LLIF and posterior fixation and 37 patients who underwent the same procedure with PLIF. We compared Japanese Orthopaedic Association (JOA) scores and perioperative complications between groups. The cross-sectional areas of the thecal sac on magnetic resonance imaging were measured before, immediately after, and 2 years after surgery. We conducted statistical analyses using unpaired t -test and Fisher’s exact tests, and a p -value <0.05 was considered statistically significant.Results: The operative time was significantly shorter in the LLIF group than in the PLIF group (115.3±33.6 min vs. 186.2±34.2 min, respectively; p <0.001). In addition, the intraoperative blood loss was significantly lower in the LLIF group than in the PLIF group (58.2±32.7 mL vs. 303.2±140.1 mL, respectively; p <0.001). We found two cases of transient lateral thigh weakness (13.3%) in the LLIF group and five cases of incidental durotomy, one case of deep infection, and one case of neurological deterioration in the PLIF group—resulting in a higher complication incidence (18.9%), although it did not reach (p =0.63). The JOA scores improved significantly in both groups.Conclusions: Indirect decompression using LLIF provided acceptable clinical and radiographical outcomes in patients with restenosis with spondylolisthesis after lumbar decompression; no revision-surgery-specific complications were found. Our results suggest that LLIF is a safe and minimally invasive procedure for revision surgery.

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Section: A B C D E Fsupporting

confidence: 81%

Section: A B C D E Fmentioning

confidence: 99%

Section: A B C D E Fmentioning

confidence: 99%

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Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery

et al. 2020

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“…Park et al showed the cage position with the anterior 1/3 of disc space was better for achieving the restoration of the segmental angle without compromising the indirect decompression [58]. Kono Though many studies have been addressed the signi cant improvements of both clinical and radiographic outcomes after LLIF, there are still some case that required myelogram (iCTM) to evaluate the effect of indirect neural decompression after LLIF [62]. They concluded iCTM evaluation might reduce the risk of unnecessary direct decompression procedure and reoperation.…”

Section: Discussionmentioning

confidence: 99%

Lateral Lumbar Interbody Fusion, Indications and Complications—An Updated Review

Chen¹,

Lai²,

Ma³

et al. 2020

Preprint

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PurposeTo perform an updated and comprehensive review of LLIF; we will also introduce a new modified LLIF named as crenel lateral interbody fusion (CLIF) to reduce the approach-related complicationsMethodsA systematic and critical review of recent literature was conducted. The sources of the data were form PubMed, MEDLINE, Embase, and Cochrane. Key search terms were "transpsoas", "interbody fusion", "LLIF", "XLIF", and “DLIF”ResultsStand-alone LLIF has the risk of cage subsidence and non-union rate. LLIF has less complication compared with other approaches because of its minimal invasive, but it still has some specific complications.ConclusionLLIF is a safe, effective and lower complication rate technique when compared to other interbody fusion methods.

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“…The patients were evaluated with intraoperative CT myelograms to assess neural decompression after cage placement, and in 9 patients, (11 levels) the CT revealed inadequate radiographic decompression of the nerve root. All of these 9 patients then underwent additional direct posterior decompression as per the authors' institutional protocol, with satisfactory outcomes [27]. Conversely, it is unclear if the improvement in direct decompression is clinically significant and affects outcomes.…”

Section: Incomplete Decompressionmentioning

confidence: 99%

Lateral and Oblique Lumbar Interbody Fusion—Current Concepts and a Review of Recent Literature

Hah

Kang

2019

Curr Rev Musculoskelet Med

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Purpose To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications. Methods A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. Recent Findings Transient neurological deficit, particularly sensorimotor symptoms of the ipsilateral thigh, remains the most common complication seen in LLIF. Best available current literature demonstrates that approximately 30-40% of patients have postoperative deficits, primarily of the proximal leg. Permanent symptoms are less common, affecting 4-5% of cases. Newer techniques to reduce this rate include different retractors, direct visualization of the nerves, and intraoperative neuromonitoring. OLIF may have lower deficit rates, but the available literature is limited. Subsidence rates in both LLIF and OLIF are comparable to ALIF (anterior lumbar interbody fusion), but further study is required. Supplemental posterior fixation is an active area of investigation that shows favorable biomechanical results, but additional clinical studies are needed. Summary Minimally invasive lumbar interbody fusion techniques continue to advance rapidly. As these techniques continue to mature, evidence-based risk-stratification systems are required to better guide both the patient and clinician in the joint decisionmaking process for the optimal surgical approach.

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The Evaluation of Indirect Neural Decompression After Lateral Lumbar Interbody Fusion Using Intraoperative Computed Tomography Myelogram

Cited by 20 publications

References 15 publications

Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery

Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery

Lateral Lumbar Interbody Fusion, Indications and Complications—An Updated Review

Lateral and Oblique Lumbar Interbody Fusion—Current Concepts and a Review of Recent Literature

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