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Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion

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Abstract

Purpose

Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an advantageous method for treating lumbar degenerative disease; however, some patients show contralateral radiculopathy postoperatively. This study aims to investigate its risk factor.

Methods

A total of 130 cases who underwent microendoscopy-assisted MIS-TLIF at L4–5 level were divided into symptomatic and asymptomatic groups according to the presence of postoperative contralateral radiculopathy. Both preoperative and postoperative radiographic parameters, as well as their changes were compared between the two groups, including lumbar lordosis (LL), surgical segmental angle (SSA), disc height (DH), contralateral foramen area (CFA) and contralateral canal area (CCA). Screw breach on contralateral L4 pedicle and decompression method (ipsilateral or bilateral canal decompression through unilateral route) were also analyzed as potential risk factors. Receiver operating characteristic (ROC) curve was drawn for the risk factor to determine the optimal threshold for predicting postoperative contralateral radiculopathy. Besides, clinical outcome assessment, involving Visual Analog Score (VAS) for back and leg, Japanese Orthopaedics Association Score (JOA) and Oswestry Disability Index (ODI), was also compared between the two groups before surgery and at final follow-up (at least 3 months after the surgery for asymptomatic patients or final treatments of contralateral radiculopathy for symptomatic cases).

Results

Postoperative contralateral radiculopathy occurred in 11 (8.5%) of the 130 patients. Both preoperative and postoperative CFA as well as its change were significantly decreased in symptomatic group compared with asymptomatic group (all P < 0.05). For the remaining four parameters (LL, SSA, DH, CCA), their preoperative, postoperative and change values showed no statistical difference between the two groups (all P > 0.05). Neither screw breach nor decompression method revealed statistical association with this complication (both P > 0.05). Based on ROC curve, the optimal threshold of preoperative CFA was 0.76 cm2. At final follow-up, significant improvement in VAS (back and leg), JOA and ODI was observed in both groups compared with preoperative baseline (all P < 0.05), while no difference was found between the two groups (all P > 0.05).

Conclusions

Preoperative contralateral foramen stenosis is the risk factor of contralateral radiculopathy following microendoscopy-assisted MIS-TLIF. If preoperative CFA at L4–5 level is not larger than 0.76 cm2, prophylactic measures, including both indirect and direct decompression of contralateral foramen, are recommended.

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References

  1. Seng C, Siddiqui MA, Wong KP et al (2013) Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976) 38:2049–2055

    Article  Google Scholar 

  2. Yang Y, Liu B, Rong LM et al (2015) Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med 8:21319–21326

    PubMed  PubMed Central  CAS  Google Scholar 

  3. Lin Y, Chen W, Chen A et al (2016) Comparison between minimally invasive and open transforaminal lumbar interbody fusion: a meta-analysis of clinical results and safety outcomes. J Neurol Surg A Cent Eur Neurosurg 77:2–10

    Article  PubMed  Google Scholar 

  4. Kim MC, Park JU, Kim WC et al (2014) Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis. Eur Spine J 23:1144–1149

    Article  PubMed  Google Scholar 

  5. Min SH, Yoo JS, Lee JY (2014) Usefulness of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion. Asian Spine J 8:453–461

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jang KM, Park SW, Kim YB et al (2015) Acute contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion. J Korean Neurosurg Soc 58:350–356

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Lin JH, Chiang YH (2014) Unilateral approach for bilateral foramen decompression in minimally invasive transforaminal interbody fusion. World Neurosurg 82:891–896

    Article  PubMed  Google Scholar 

  8. Hari A, Krishna M, Rajagandhi S et al (2016) Minimally invasive transforaminal lumbar interbody fusion-indications and clinical experience. Neurol India 64:444–454

    Article  PubMed  Google Scholar 

  9. Schwender JD, Holly LT, Rouben DP et al (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18:S1–S6

    Article  PubMed  Google Scholar 

  10. Hunt T, Shen FH, Shaffrey CI et al (2007) Contralateral radiculopathy after transforaminal lumbar interbody fusion. Eur Spine J 16:311–314

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rajasekaran S, Vidyadhara S, Ramesh P et al (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 32:E56–E64

    Article  CAS  Google Scholar 

  12. Hackenberg L, Halm H, Bullmann V et al (2005) Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 14:551–558

    Article  PubMed  PubMed Central  Google Scholar 

  13. Orita S, Inage K, Eguchi Y et al (2016) Lumbar foramen stenosis, the hidden stenosis including at L5/S1. Eur J Orthop Surg Traumatol 26:685–693

    Article  PubMed  Google Scholar 

  14. Iwata T, Miyamoto K, Hioki A et al (2015) Morphologic changes in contralateral lumbar foramen in unilateral cantilever transforaminal lumbar interbody fusion using kidney-type intervertebral spacers. J Spinal Disord Tech 28:E270–E276

    Article  PubMed  Google Scholar 

  15. Yan DL, Pei FX, Li J et al (2008) Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J 17:1311–1316

    Article  PubMed  PubMed Central  Google Scholar 

  16. Abdul QR, Qayum MS, Saradhi MV et al (2011) Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: which is better? J Craniovertebr Junction Spine 2:12–16

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Katzell J (2014) Endoscopic foramen decompression preceding oblique lateral lumbar interbody fusion to decrease the incidence of post operative dysaesthesia. Int J Spine Surg 8:19

    Article  PubMed Central  Google Scholar 

  18. Bai J, Zhang W, Zhang X et al (2015) A clinical investigation of contralateral neurological symptom after transforaminal lumbar interbody fusion (TLIF). Med Sci Monit 21:1831–1838

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim SB, Jeon TS, Heo YM et al (2009) Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease: focusing on changes of segmental lordosis in fusion segment. Clin Orthop Surg 1:207–213

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bach CM (2007) Comment on the paper “Contralateral radiculopathy after transforaminal lumbar interbody fusion” (Travis Hunt et al.). Eur Spine J 16:S315

    Article  Google Scholar 

  21. Than KD, Mummaneni PV (2014) Unilateral approach for bilateral decompression with MIS TLIF. World Neurosurg 82:646–647

    Article  PubMed  Google Scholar 

  22. Ren Z, Liu A, Yang K et al (2017) Evaluation of changes in lumbar neuroforaminal dimensions in symptomatic young adults using positional MRI. Eur Spine J 26:1999–2006

    Article  PubMed  Google Scholar 

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Acknowledgements

We deeply thank Lianxiong Yuan for performing statistical analysis of this study.

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Authors and Affiliations

  1. Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People’s Republic of China

    Yang Yang, Zhong-Yu Liu, Liang-Ming Zhang, Jian-Wen Dong, Pei-Gen Xie, Rui-Qiang Chen, Bu Yang, Chang Liu, Bin Liu & Li-Min Rong

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  1. Yang Yang
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  2. Zhong-Yu Liu
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  3. Liang-Ming Zhang
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  4. Jian-Wen Dong
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  5. Pei-Gen Xie
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  6. Rui-Qiang Chen
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  7. Bu Yang
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  8. Chang Liu
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  9. Bin Liu
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  10. Li-Min Rong
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Correspondence to Bin Liu or Li-Min Rong.

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No benefit in any form has been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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No funds or Grants were received in support of this work.

Additional information

Yang Yang and Zhong-Yu Liu are co-authors.

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Yang, Y., Liu, ZY., Zhang, LM. et al. Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 27, 1925–1932 (2018). https://doi.org/10.1007/s00586-017-5417-8

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  • DOI: https://doi.org/10.1007/s00586-017-5417-8

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