Factors that influence the results of indirect decompression employing oblique lumbar interbody fusion

Abstract

BACKGROUND

Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis. On the other hand, the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.

AIM

To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.

METHODS

This study is a single-center cross-sectional evaluation of 80 consecutive patients (17 males and 63 females) with lumbar spinal stenosis combined with the instability of the lumbar spinal segment. Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion (OLIF) with percutaneous pedicle screw fixation. Radiographic results of the indirect decompression were assessed using computerized tomography, while MacNab scale was used to assess clinical results.

RESULTS

After indirect decompression employing anterior reconstruction using OLIF, the statistically significant increase in the disc space height, vertebral canal square, right and left lateral canal depth were detected (Р < 0.0001). The median (M) relative vertebral canal square increase came to М = 24.5% with 25%-75% quartile border (16.3%; 33.3%) if indirect decompression was achieved by restoration of the segment height. In patients with the reduction of the upper vertebrae slip, the median of the relative increase in vertebral canal square accounted for 49.5% with 25%-75% quartile border (2.35; 99.75). Six out of 80 patients (7.5%) presented with unsatisfactory results because of residual nerve root compression. The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm² respectively.

CONCLUSION

Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis. Vertebral canal square below 80 mm² and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.

Keywords: Indirect decompression; Anterior reconstruction; Central lumbar spinal stenosis; Degenerative spondylolisthesis; Lateral recess stenosis; Spinal instability; Oblique lateral interbody fusion

Core Tip: This is a cross-sectional study of 80 patients who underwent oblique lateral interbody fusion. The radiographic results were measured using computed tomography while clinical results were assessed using MacNab Scale and cases with unresolved nerve root compression were registered. Indirect decompression is achieved by segment height restoration and the reduction of slipped vertebra. Using multivariate regression modeling it has been evaluated that postoperative spinal canal square is more predictable than the lateral recess depth. Marginal values of the lateral recess depth that can be used for the prediction of unsatisfactory results according to MacNab scale were estimated.