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The Effect of Indirect Decompression Through Extraforaminal Interbody Fusion for Degenerative Lumbar Disease

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Abstract

Purpose

Extraforaminal lumbar interbody fusion as with other methods that involve the mechanism of indirect decompression, the discussion not only focuses on the benefit of minimizing the risk of thecal sac injury and postoperative scarring, but also on the risk of insufficient decompression in the affected neural structures during the reduction of the affected segment.

Methods

Eighty-two patients presenting with degenerative lumbar disease with segmental instability underwent ELIF combined with transpedicular fixation and circumferential fusion. Clinical and radiographic evaluations were performed.

Results

The mean ODI significantly improved from 63.4 preoperatively to 32.3 1 year postoperatively. The mean VAS back pain significantly improved from 5.95 to 2.63 postoperatively and VAS (leg pain) improved from 6.04 to 2.44. The mean CSA increased from 103  mm2 preoperatively to 169  mm2 postoperatively. The median extension ratio of CSA was 33%. Disc height, segmental disc angle, and lumbar lordosis also improved significantly. Only three (3.7%) patients were revised using direct central decompression due to neurologic deterioration.

Conclusion

Spinal stenosis was resolved successfully by indirect decompression through extraforaminal interbody fusion via a transmuscular limited approach.

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Acknowledgements

Data statistics, Patrícia Martinková, Ph.D., Department of Statistical Modelling, Institute of Computer Science, Czech Academy of Sciences, Pod Vodárenskou věží 2, 182 07 Prague, Czech Republic, Web: https://www.cs.cas.cz/martinkova/.

Funding

This work was supported by the internal project of Bulovka University Hospital grant nr. “22-IGS07-12”. Supported by Ministry of Health, Czech Republic – conceptual development of research organization (FNBul, 00064211).

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Authors and Affiliations

  1. The Orthopaedic Clinic of the 1st Medical Faculty, Charles University, Prague, The University Hospital Bulovka, Budínova 2, 180 81, Prague 8, Czech Republic

    Josef Vcelak, Adam Kral, Andrea Speldova & Ladislav Toth

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  1. Josef Vcelak
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  2. Adam Kral
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  3. Andrea Speldova
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Josef Vcelak, Adam Kral, Adrea Speldova, and Ladislav Toth. The first draft of the manuscript was written by Josef Vcelak and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Josef Vcelak.

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Conflict of interest

All authors declare, that they have no relevant or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

The study was performed with the approval of the institutional ethics committee of the university hospital (University Hospital Bulovka, Prague, Czech Republic, 1 July 2022). This study was performed in line with the principles of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Vcelak, J., Kral, A., Speldova, A. et al. The Effect of Indirect Decompression Through Extraforaminal Interbody Fusion for Degenerative Lumbar Disease. JOIO 57, 2058–2065 (2023). https://doi.org/10.1007/s43465-023-01008-z

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  • DOI: https://doi.org/10.1007/s43465-023-01008-z

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