Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Woo Jong Kim; Yong Cheol Hong; Jae Wan Soh; Chang Hyun Kim; Chang Hwa Hong; Heejun Jang

doi:10.4184/jkss.2019.26.4.126

Journal List > J Korean Soc Spine Surg > v.26(Suppl 1) > 1142093

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Kim, Hong, Soh, Kim, Hong, and Jang: Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Original Article

Journal of Korean Spine Surg 2019;26(4):126-131.

Published online: 31 December 2019

DOI: https://doi.org/10.4184/jkss.2019.26.4.126

Comparative Measurements of Preoperative and Postoperative Radiological and Clinical Parameters of Direct Lumbar Interbody Fusion in Degenerative Spinal Disease Patients

Woo Jong Kim, M.D.^†, Yong Cheol Hong, M.D.^†, Jae Wan Soh, M.D., Chang Hyun Kim, M.D., Chang Hwa Hong, M.D., Heejun Jang, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea

Corresponding author: Chang Hwa Hong, M.D. ORCID ID: Woo Jong Kim: https://orcid.org/0000-0002-4579-1008 Yong Cheol Hong: https://orcid.org/0000-0003-2002-5021 Jae Wan Soh: https://orcid.org/0000-0003-0930-066X Chang Hyun Kim: http://orcid.org/0000-0002-2539-1058 Heejun Jang: https://orcid.org/0000-0001-5761-7317 Chang Hwa Hong: https://orcid.org/0000-0003-0744-124X Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151 Korea TEL: +82-41-570-2176, FAX: +82-41-572-7234 E-mail: chhong@sch.ac.kr

^† These Authors Contributed Equally to This Study as the Co-first Author

Received 1 August 201926 August 2019 Accepted 1 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study of prospectively-collected data.

Objectives

To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF).

Summary of Literature Review

DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea.

Materials and Methods

We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients’ visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters.

Results

Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level.

Conclusions

DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis, and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae.

Keywords: Spinal stenosis, Spinal fusion, Direct lateral lumbar interbody fusion

REFERENCES

1. McAfee PC, Regan JJ, Geis WP, et al. Minimally invasive anterior retroperitoneal approach to the lumbar spine: em-phasis on the lateral BAK. Spine. 1998 Jul 1; 23(13):1476–84. DOI: 10.1097/00007632-199807010-00009.

2. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. The Spine Journal. 2006 Jul-Aug; 6:435–43. DOI: 10.1016/j.spinee.2005.08.012.

3. Acosta FL, Liu J, Slimack N, et al. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. Journal of Neurosurgery. 2011 Jul; 15:92–6. DOI: 10.3171/2011.3.spine10425.

4. Elowitz EH, Yanni D, Chwajol M, et al. Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. J min-Minimally Invasive Neurosurgery. 2011 Oct; 54:201–6. DOI: 10.1055/s-0031-1286334.

5. Johnson R, Valore A, Villaminar A, et al. Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease. Journal of Clinical Neuroscience. 2013 Apr; 20:576–81. DOI: 10.1016/j.jocn.2012.05.032.

6. Malham GM, Parker RM, Goss B, et al. Indirect foraminal decompression is independent of metabolically active facet arthropathy in extreme lateral interbody fusion. Spine. 2014 Oct; 39:E1303–E10. DOI: 10.1097/brs.0000000000000551.

7. Oliveira L, Marchi L, Coutinho E, et al. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural ele-ments. Spine. 2010 Dec; 35:S331–S7. DOI: 10.1097/brs.0b013e3182022db0.

8. Kotwal S, Kawaguchi S, Lebl D, et al. Minimally invasive lateral lumbar interbody fusion. Journal of Spinal Disorders and Techniques. 2015 May; 28:119–25. DOI: 10.1097/BSD.0b013e3182706ce7.

9. Lang G, Perrech M, Navarro-Ramirez R, et al. Potential and limitations of neural decompression in extreme lateral interbody fusion—a systematic review. World neurosurgery. 2017 May; 101:99–113. DOI: 10.1016/j.wneu.2017. 01.080.

10. Rao PJ, Maharaj MM, Phan K, et al. Indirect foraminal decompression after anterior lumbar interbody fusion: a prospective radiographic study using a new pedicle-to-pedicle technique. The Spine Journal. 2015 May; 15:817–24. DOI: 10.1016/j.spinee.2014.12.019.

11. Cho C-B, Ryu K-S, Park C-K. Anterior lumbar interbody fusion with standalone interbody cage in treatment of lumbar intervertebral foraminal stenosis: comparative study of two different types of cages. Journal of Korean Neurosurgical Society. 2010 May; 47:352. DOI: 10.3340/jkns.2010.47.5.352.

12. Goyal A, Kerezoudis P, Alvi MA, et al. Outcomes following minimally invasive lateral transpsoas interbody fusion for degenerative low grade lumbar spondylolisthesis: a systematic review. Clinical neurology. 2018 Apr; 167:122–8. DOI: 10.1016/j.clineuro.2018.02.020.

13. Pawar AY, Hughes AP, Sama AA, et al. A comparative study of lateral lumbar interbody fusion and posterior lumbar interbody fusion in degenerative lumbar spondylolis-thesis. Asian spine journal. 2015 Oct; 9:668. DOI: 10.4184/asj.2015.9.5.668.

14. Louie PK, Varthi AG, Narain AS, et al. Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion. The Spine Journal. 2018 Nov; 18:2025–32. DOI: 10.1016/j.spinee.2018.04.008.

Table 1.

Summary of patients’ demographic characteristics and treated levels

Patients (n=44)
Sex
Male	9(20.5%)
Female	35(79.5%)
Treated segments
Single segment	13(29.5%)
2 segments	18(41.0%)
3 segments	13(29.5%)
Treated level (n=89)
L1-2	2(2.2%)
L2-3	24(27.0%)
L3-4	38(42.7%)
L4-5	24(27.0%)
L5-S1	1(1.1%)

Table 2.

Primary diagnosis of the patients

Primary diagnosis (n=44)
Spondylolisthesis	9(20.5%)
Foraminal stenosis	11(25.0%)
Degenerative scoliosis	11(25.0%)
Adjacent segmental disease (ASD)	13(29.5%)

Table 3.

Comparison between preoperative and postoperative radiological measures

Treated level (n=89)
	Preoperative	Postoperative	∆	∆ (%)	p-value
Ant. disc height (DH)	6.8±2.1	11.7±2.2	4.9	86.0	<0.001
Post. disc height (DH)	5.7±2.0	9.5±1.9	3.8	84.3	<0.001
Foraminal height (FH) Rt.	6.0±2.6	7.4±3.4	1.5	25.6	<0.001
Foraminal height (FH) Lt.	6.1±2.4	7.4±3.3	1.3	20.8	<0.001
Cross-sectional area (CSA)	97.9±32.3	133±23.1	35.1	33.1	<0.001

Table 4.

Comparison between preoperative and postoperative clinical parameters

Treated level (n=89).
	Preoperative	POD 1 year	∆	∆ (%)	p-value
VAS LBP	4.5±1.4	1.3±1.0	3.3	65.7	<0.001
VAS But	5.0±1.5	1.7±1.2	3.3	61.1	<0.001
VAS Leg	5.0±1.4	1.8±1.3	3.2	59.3	<0.001
ODI	50.0±11.2	15.8±5.9	34.1	67.6	<0.001

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