Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience

April 21, 2023

doi: 10.3389/fsurg.2023.1158836.

eCollection 2023.

Salvatore Petrone^{1

2}, Marco Ajello³, Nicola Marengo³, Marco Bozzaro¹, Alessandro Pesaresi², Mario Allevi², Alessandro Fiumefreddo³, Federica Denegri⁴, Maurizio Cogoni⁴, Andrea Garnero⁴, Fulvio Tartara¹, Giuseppe Di Perna^{2

5}, Daniele Armocida⁶, Alessandro Pesce⁷, Alessandro Frati⁶, Francesco Zenga⁸, Diego Garbossa^{2

3}, Fabio Cofano^{1

2}

Affiliations

¹ Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy.
² Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy.
³ Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy.
⁴ Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy.
⁵ Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy.
⁶ Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy.
⁷ Neurosurgery Unit, Ospedale Santa Maria Goretti, Latina, Italy.
⁸ Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy.

Item in Clipboard

Salvatore Petrone et al.

Front Surg.

2023.

doi: 10.3389/fsurg.2023.1158836.

eCollection 2023.

Authors

Affiliations

¹ Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy.
² Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy.
³ Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy.
⁴ Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy.
⁵ Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy.
⁶ Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy.
⁷ Neurosurgery Unit, Ospedale Santa Maria Goretti, Latina, Italy.
⁸ Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy.

Item in Clipboard

Abstract

Introduction:

Evaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome.

Materials and methods:

From 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire).

Results:

72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p < 0.001), height of the foramina (p < 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p < 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis.

Conclusions:

LLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements.

Keywords:

LLIF; XLIF; indirect decompression; predictive factors; spondylolisthesis.

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**

Pre- and post-operative clinical outcomes. The mean values of VAS leg, VAS back, ODI and Swiss Spinal Stenosis Questionnaire. Note: *P < 0.05; VAS, Visual Analog Scale; ODI, Oswestry Disability Index.

**Figure 2**

Pre- and post-operative comparison on MRI scans. Measurement of pre and post-op central canal area (**A,B**), foramen area (**C,D**), thickness of the yellow ligament (**E,F**). Example of reduction of degenerative spondylolisthesis through indirect LLIF decompression technique (**G,H**).

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