. 2021 Dec 9;13(12):e20302.
doi: 10.7759/cureus.20302.
eCollection 2021 Dec.
Affiliations
Affiliations
- 1 Neurosurgery and Oncology, University of Rochester Medical Center, Rochester, USA.
- 2 Orthopaedics, Guanghua Hospital, Shanghai, CHN.
- 3 Research, Globus Medical Inc., Audubon, USA.
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Yan M Li et al.
Cureus.
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. 2021 Dec 9;13(12):e20302.
doi: 10.7759/cureus.20302.
eCollection 2021 Dec.
Affiliations
- 1 Neurosurgery and Oncology, University of Rochester Medical Center, Rochester, USA.
- 2 Orthopaedics, Guanghua Hospital, Shanghai, CHN.
- 3 Research, Globus Medical Inc., Audubon, USA.
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Abstract
Introduction Interbody spacers are necessary for achieving disc height restoration when surgical intervention is used for the treatment of severe degenerative disc disease. Minimally invasive lateral lumbar interbody fusion (MIS LLIF) is a popular surgical approach that historically uses large static interbody spacers through a lateral approach. However, static spacers have been associated with iatrogenic distraction and excessive impaction forces, which may increase the risk of subsidence and loss of lordosis, compromising stability. Expandable interbody spacers with or without adjustable lordosis may help address these concerns by maximizing segmental lordosis and aiding in sagittal balance correction. This study describes the clinical and radiographic outcomes of patients treated with expandable interbody spacers with or without adjustable lordosis, for MIS LLIF. Materials and methods This is retrospective, single-surgeon Institutional Review Board-exempt chart review was of 103 consecutive patients who had undergone MIS LLIF at one to two contiguous level(s) utilizing expandable interbody spacers with or without adjustable lordosis (66/103 patients had adjustable lordosis spacers). Collection of clinical and radiographic functional outcomes occurred at preoperative and postoperative time points through 24 months. Results One-hundred and three consecutive patients were evaluated-average age, 58.2 ± 12.1 years; 42.1% (45/107) were female. There were 78.6% (81/103) one-level cases and 21.4% (22/103) two-level cases for a total of 125 levels; 44.8% (56/125) were performed at L4-5 and 34.4% (43/125) at L3-4. The average estimated blood loss was 24.6 ± 12.3cc. Mean operative time was 61.0 ± 19.1 min, and mean fluoroscopic time was 28.2 ± 14.6 sec. Visual Analog Scale (VAS) back and leg pain scores decreased significantly by an average of 7.1 ± 1.0 points at 24 months (p<0.001). Oswestry Disability Index (ODI) scores significantly decreased by a mean of 67.4 ± 8.9 points at 24 months (p<0.001). Lumbar lordosis significantly improved by a mean of 3.1 ± 8.8° at 24 months (p=0.001). Anterior, middle, and posterior disc height significantly increased at 24 months by averages of 4.7 ± 3.1, 4.0 ± 3.0, and 2.1 ± 2.2mm, respectively (p<0.001). Neuroforaminal height had significantly increased at 24 months by a mean of 3.0 ± 3.6mm (p<0.001). Segmental lordosis significantly improved by 3.7 ± 2.9° at 24 months (p<0.001). There were 51 patients with abnormal preoperative Pelvic Incidence-Lumbar Lordosis (PI-LL) measurements that significantly improved by 9.1 ± 4.9° (p<0.001) and 52 patients with normal preoperative PI-LL measurements that improved by 0.2 ± 4.6° (p=0.748) at 24 months. One-hundred percent fusion occurred at all levels, and no findings of radiolucency were observed. One case of subsidence (1/125, 0.8%) was reported at 24 months. No implanted-related complications were reported, with 0% pseudoarthrosis and no secondary surgery required at the operative levels. Conclusion Indirect decompression and sagittal correction were achieved and maintained through a 24-month follow-up. Functional clinical outcomes significantly improved based on decreased VAS pain and ODI scores at 24 months. This study resulted in positive clinical and radiographic outcomes for patients who underwent MIS LLIF with expandable interbody spacers with or without adjustable lordosis.
Keywords:
adjustable lordosis; degenerative disc disease; expandable interbody spacers; mis llif; sagittal correction.
Copyright © 2021, Li et al.
Conflict of interest statement
The authors have declared financial relationships, which are detailed in the next section.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i01.gif)
Figure 1. Expandable interbody spacer with adjustable…
Figure 1. Expandable interbody spacer with adjustable lordosis (RISE®-AL, Globus Medical, Inc., Audubon, Pennsylvania, USA)…
Figure 1. Expandable interbody spacer with adjustable lordosis (RISE®-AL, Globus Medical, Inc., Audubon, Pennsylvania, USA) in expanded and minimized forms
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i02.gif)
Figure 2. Expandable interbody spacer (RISE®-L, Globus…
Figure 2. Expandable interbody spacer (RISE®-L, Globus Medical, Inc., Audubon, Pennsylvania, USA)
Figure 2. Expandable interbody spacer (RISE®-L, Globus Medical, Inc., Audubon, Pennsylvania, USA)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i03.gif)
Figure 3. Implant graft chamber
Figure 3. Implant graft chamber
Additional autogenous bone graft may be packed into the graft…
Figure 3. Implant graft chamber
Additional autogenous bone graft may be packed into the graft chamber of the implant after expansion and around the implant if desired.
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i04.gif)
Figure 4. Standing lateral lumbar spine radiograph…
Figure 4. Standing lateral lumbar spine radiograph with superimposed lines displaying the measurements evaluated in…
Figure 4. Standing lateral lumbar spine radiograph with superimposed lines displaying the measurements evaluated in this study
Measurements included disc heights, neuroforaminal height, segmental lordosis, and lumbar lordosis
![Figure 5](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i05.gif)
Figure 5. Mean VAS back pain
Figure 5. Mean VAS back pain
The results show a significant decrease in VAS back…
Figure 5. Mean VAS back pain
The results show a significant decrease in VAS back pain scores from baseline and sustained at 1.5, 3, 6, 12, and 24 months. VALAL/L- are the mean VAS scores for AL and L patients combined (103 patients); VASAL-AL patients only (66 patients); VASL-L patients only (37 patients) VAS: Visual Analog Scale; AL: expandable interbody spacer with adjustable lordosis; L: expandable interbody spacer without adjustable lordosis
![Figure 6](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i06.gif)
Figure 6. Mean ODI scores
Figure 6. Mean ODI scores
The results show a significant decrease in ODI back scores…
Figure 6. Mean ODI scores
The results show a significant decrease in ODI back scores from baseline and sustained at 1.5, 3, 6, 12, and 24 months. ODI.AL/L- mean scores for AL and L patients combined (103), ODI.AL- AL patients only (66), and ODI.L- L patients only (37) ODI: Oswestry Disability Index; AL: expandable interbody spacer with adjustable lordosis; L: expandable interbody spacer without adjustable lordosis
![Figure 7](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8748004/bin/cureus-0013-00000020302-i07.gif)
Figure 7. Average anterior, middle, posterior disc…
Figure 7. Average anterior, middle, posterior disc heights and neuroforaminal heights
Significant improvement from baseline…
Figure 7. Average anterior, middle, posterior disc heights and neuroforaminal heights
Significant improvement from baseline (preop) values were achieved at 6 weeks, 3, 6, and 12 months postoperatively, and sustained at 24-month follow-up. ADH: anterior disc height; MDH: middle disc height; PDH: posterior disc heights; NFH: neuroforaminal height
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