Oblique Lumbar Interbody Fusion Using a Stand-Alone Construct for the Treatment of Adjacent-Segment Lumbar Degenerative Disease

April 19, 2022

doi: 10.3389/fsurg.2022.850099.

eCollection 2022.

Affiliations

Item in Clipboard

Wang Kai et al.

Front Surg.

2022.

Abstract

Objective:

Adjacent-segment disease (ASD) is common in patients undergone previous lumbar fusion. A typical revision treatment from posterior approach requires management of postoperative scar tissue and previously implanted instrumentation. An oblique lumbar interbody fusion (OLIF) approach allows surgeon to reduce the potential risk of posterior approach. This study aimed to analyze the clinical and radiographic efficacy of stand-alone OLIF for the treatment of lumbar adjacent-segment disease.

Methods:

A total of 13 consecutive patients who underwent stand-alone OLIF for the treatment of adjacent-segment disease from December 2016 to January 2019 were reviewed. Visual analog scale (VAS) of back pain and leg pain and the Oswestry Disability Index (ODI) before surgery and at last postoperative clinic visits were obtained. Radiography, CT and MRI before and at last follow-up after surgery was evaluated in all patients.

Results:

During the study period, 13 cases were successfully treated with stand-alone OLIF. The mean follow-up was 17.7 ± 8.3 months. The back pain VAS improved from 6.2 ± 1.0 to 2.0 ± 1.1 (P < 0.01), and the leg pain VAS improved from 7.0 ± 1.9 to 1.0 ± 0.9 (P < 0.01). ODI improved from 28.0 ± 7.5 to 10.8 ± 4.0 (P < 0.01). The disc height (DH) increased from 9 ± 2 to 12 ± 2 mm (P < 0.01), the cross-sectional area (CSA) of spinal canal increased from 85 ± 26 to 132 ± 24 mm² (P < 0.01), the foraminal height increased from 17 ± 2 to 21 ± 3 mm (P < 0.01) and the CSA of foramen increased from 95 ± 25 to 155 ± 36 mm² (P < 0.01). Cage subsidence was observed in 2 cases.

Conclusions:

Stand-alone OLIF provides a safe and effective alternative way to treat ASD.

Keywords:

Oswestry Disability Index; adjacent-segment disease; oblique lumbar interbody fusion; stand-alone; visual analog scale.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**

Images obtained in a 62-year-old woman who had an L4–L5 posterior instrumented fusion 6 years earlier. She experienced new back and leg pain and intermittent claudication due to adjacent-segment degeneration and stenosis for 3 months. **(A)** Pre-operative sagittal MRI; **(B)** Sagittal MRI at last follow-up post-operative; **(C)** Pre-operative axial MRI through the L3–4 and CSA (the yellow contour line illustrates); **(D)** Post-operative axial MRI through the L3–4 and CSA (the yellow contour line illustrates).

**Figure 2**

Images obtained in the same patient. Disk height **(A,D)**, foraminal height **(B,E)**, and foraminal CSA **(C,F)** were evaluated with CT before and at last follow-up after surgery. **(A–C)** are before surgery, and **(D–F)** are at last follow-up after surgery.

**Figure 3**

Images obtained in a 66-year-old woman who had an L4–L5 posterior instrumented fusion 26 month ago. She experienced new leg pain and intermittent claudication due to adjacent-segment degeneration and stenosis for 2 months. **(A)** 18 months follow-up reviewed Grade I subsidence; **(B)** CT confirmed bony fusion was achieved; **(C,D)** Indirect decompression of spinal canal was maintained.

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