Minimally Invasive Lateral Lumbar Interbody Fusion: Indications, Outcomes and Complications

Soh Jaewan; Chul Lee Jae

doi:10.4055/jkoa.2019.54.3.203

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Jaewan and Jae: Minimally Invasive Lateral Lumbar Interbody Fusion: Indications, Outcomes and Complications

Original Article

J Korean Orthop Assoc 2019;54(3):203-210.

DOI: https://doi.org/10.4055/jkoa.2019.54.3.203

Minimally Invasive Lateral Lumbar Interbody Fusion: Indications, Outcomes and Complications

Soh Jaewan, M.D., Chul Lee Jae, M.D.^∗

Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan

Correspondence to: Jae Chul Lee, M.D. Department of Orthopedic Surgery and Spine Center, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea TEL: +82-2-709-9250 FAX: +82-2-794-9414 E-mail: jlee@schmc.ac.kr ORCID: https://orcid.org/0000-0002-8272-6723

^* Department of Orthopedic Surgery and Spine Center, Soonchunhyang University Seoul Hospital, Seoul, Korea

Received 29 August 20184 October 2018 Accepted 15 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The aim of this review was to evaluate minimally invasive lateral lumbar interbody fusion on the latest update. Lumbar interbody fusion was introduced recently. This study performed, a literature review of the indications, clinical outcomes, fusion rate, and complications regarding recently highlighted minimally invasive lateral lumbar interbody fusion. The indications of lateral lumbar interbody fusion are similar to the conventional anterior and posterior interbody fusion in degenerative lumbar diseases. In particular, lateral lumbar interbody fusion is an effective minimally invasive surgery in spinal stenosis, degenerative spondylolisthesis, degenerative adult deformity, degenerative disc disease and adjacent segment disease. In addition, the clinical outcomes and fusion rates of lateral lumbar interbody fusion are similar compared to conventional lumbar fusion. On the other hand, non-specific complications including hip flexor weakness, nerve injury, vascular injury, visceral injury, cage subsidence and pseudohernia have been reported. Lateral lumbar interbody fusion is a very useful minimally invasive surgery because it has advantages over conventional anterior and posterior interbody fusion without many of the disadvantages. Nevertheless, nonspecific complications during lateral lumbar interbody fusion procedure remain a challenge to be improved.

Keywords: lumbar, degenerative lumbar disease, lateral lumbar interbody fusion

References

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Figure 1.

(A) Preoperative T2-weighted magnetic resonance (MR) sagittal image shows spinal foraminal stenosis due to a narrowing of the disc height on L3–4 (arrow). (B) Preoperative T2-weighted MR sagittal image shows spinal central stenosis due to hypertrophy of ligament flavum on L3–4 (arrow). (C) After lateral lumbar interbody fusion and posterior percutaneous screw fixation, the T2-weighted MR sagittal image shows widening of foramen due to restoration of disc height on L3–4 (arrow). This shows indirect foraminal decompression. (D) After lateral lumbar interbody fusion and posterior percutaneous screw fixation, the T2-weighted MR sagittal image shows widening of the neural canal due to distraction of ligament flavum on L3–4 (arrow). This shows indirect central decompression.

Figure 2.

(A) Preoperative and postoperative whole spine anterolateral standing plain X-rays show degenerative scoliosis on lumbar spine was corrected. (B) Preoperative and postoperative whole spine lateral standing plain X-rays show that the degenerative kyphosis on lumbar spine had been corrected. LL, lumbar lordosis; SS, sacral slope; PT, pelvic tilt.

Table 1.

Indications and Contra-Indications for Lateral Lumbar Interbody Fusion

Indications

Spinal stenosis – central, foraminal

Degenerative spondylolisthesis

Degenerative adult deformity

Degenerative disc disease

Adjacent segment disease

Contraindications

Endplate fracture

Severe osteoporosis

Active infection

Past history of retroperitoneal infection or surgery

Sequestrated herniated intervertebral disc

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