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Extreme lateral interbody fusion for unilateral symptomatic vertical foraminal stenosis

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Abstract

Purpose

Asymmetric loss of disc height in adult deformity patients may lead to unilateral vertical foraminal stenosis and radiculopathy. The current study aimed to investigate whether restoration of foraminal height on the symptomatic side using extreme lateral interbody fusion (XLIF) would alleviate unilateral radiculopathy.

Methods

In a retrospective study, patients with single-level unilateral vertical foraminal stenosis and corresponding radicular pain undergoing XLIF were included. Functional data (visual analog scale (VAS) for buttock, leg and back, as well as Oswestry Disability Index (ODI)) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle and regional lumbar lordosis) were collected preoperatively, postoperatively and at the last follow-up.

Results

Twenty-three patients were included, among whom 61 % had degenerative scoliosis. History of previous surgery at the level of index was present in 43 % of patients. Additional instrumentation was performed in 91 %. The foraminal height on the stenotic side was significantly increased postoperatively (p < 0.001), and remained significantly increased at the last follow-up of 11 ± 3.7 months (p < 0.001). Additionally, VAS buttock and leg on the stenotic side, VAS back and ODI were significantly improved postoperatively and at the last follow-up (p ≤ 0.001 for all parameters). The foraminal height on the stenotic side showed correlation with the VAS leg on the stenotic side, both postoperatively and the last follow-up (r = −0.590; p = 0.013, and r = −0.537; p = 0.022, respectively).

Conclusions

Single-level XLIF is an effective procedure for treatment of symptomatic unilateral foraminal stenosis leading to radiculopathy. In deformity patients with radicular pain caused by nerve compression at a single level, when not associated with other symptoms attributable to general scoliosis, treatment with single-level XLIF can result in short- and mid-term satisfactory outcome.

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References

  1. Hasegawa T, An HS, Haughton VM, Nowicki BH (1995) Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am 77:32–38

    CAS  PubMed  Google Scholar 

  2. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res (157):191–199

  3. Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35:S331–S337. doi:10.1097/BRS.0b013e3182022db0

    Article  Google Scholar 

  4. Elowitz EH, Yanni DS, Chwajol M, Starke RM, Perin NI (2011) Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg 54:201–206. doi:10.1055/s-0031-1286334

    Article  CAS  PubMed  Google Scholar 

  5. Kepler CK, Sharma AK, Huang RC, Meredith DS, Girardi FP, Cammisa FP Jr, Sama AA (2012) Indirect foraminal decompression after lateral transpsoas interbody fusion. J Neurosurg Spine 16:329–333. doi:10.3171/2012.1.SPINE11528

    Article  PubMed  Google Scholar 

  6. Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443. doi:10.1016/j.spinee.2005.08.012

    Article  PubMed  Google Scholar 

  7. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294

    Article  CAS  PubMed  Google Scholar 

  8. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158

    Article  CAS  PubMed  Google Scholar 

  9. Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20. doi:10.1007/s00586-002-0464-0

    CAS  PubMed  Google Scholar 

  10. Mummaneni PV, Wang MY, Silva FE, Lenke LG, Ziewacz JE, Amin BY, Tu T-H (2014) The MiSLAT Algorithm: minimally invasive evaluation and treatment for adult degenerative deformity. In: Wang MY (ed) Minimally invasive spinal deformity surgery: an evolution of modern techniques. Springer, Wien, pp 67–74

    Chapter  Google Scholar 

  11. Silva FE, Lenke LG (2010) Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 28:E1. doi:10.3171/2010.1.FOCUS09271

    Article  PubMed  Google Scholar 

  12. Jackson RP, Glah JJ (1987) Foraminal and extraforaminal lumbar disc herniation: diagnosis and treatment. Spine 12:577–585

    Article  CAS  PubMed  Google Scholar 

  13. Ozeki N, Aota Y, Uesugi M, Kaneko K, Mihara H, Niimura T, Saito T (2008) Clinical results of intrapedicular partial pediculectomy for lumbar foraminal stenosis. J Spinal Disord Tech 21:324–327. doi:10.1097/BSD.0b013e318149e681

    Article  PubMed  Google Scholar 

  14. Yeom JS, Kim KH, Hong SW, Park KW, Chang BS, Lee CK, Buchowski JM (2008) A minimally invasive technique for L5–S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach. J Neurosurg Spine 8:193–198. doi:10.3171/spi/2008/8/2/193

    Article  PubMed  Google Scholar 

  15. Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976) 13:696–706

    Article  CAS  Google Scholar 

  16. Ruetten S, Komp M, Hahn P (2012) Endoscopic disc and decompression surgery. In: Hartl R, Korge A (eds) Minimally invasive spine surgery—techniques, evidence, and controversies. Thieme, New York, pp 315–330

    Google Scholar 

  17. Lauryssen C (2010) Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis. Spine (Phila Pa 1976) 35:S287–S293. doi:10.1097/BRS.0b013e3182023268

    Article  Google Scholar 

  18. Dickinson LD, Phelps J, Summa CD, Vanichkachorn JS, Jeshuran WR, Randall JB, Mimran RI, Mitchell M, Macenski MM, Lauryssen C (2013) Facet-sparing decompression with a minimally invasive flexible microblade shaver: a prospective operative analysis. J Spinal Disord Tech. doi:10.1097/BSD.0b013e318290fc62

    PubMed  Google Scholar 

  19. Knight MT, Vajda A, Jakab GV, Awan S (1998) Endoscopic laser foraminoplasty on the lumbar spine—early experience. Minim Invasive Neurosurg 41:5–9. doi:10.1055/s-2008-1052006

    Article  CAS  PubMed  Google Scholar 

  20. Alimi M, Njoku I Jr, Cong GT, Pyo SY, Hofstetter CP, Grunert P, Hartl R (2014) Minimally invasive foraminotomy through tubular retractors via a contralateral approach in patients with unilateral radiculopathy. Neurosurgery. doi:10.1227/neu.0000000000000358

    PubMed  Google Scholar 

  21. Chang SB, Lee SH, Ahn Y, Kim JM (2006) Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine 31:1163–1167. doi:10.1097/01.brs.0000216431.69359.91

    Article  PubMed  Google Scholar 

  22. Weidenbaum M (2006) Considerations for focused surgical intervention in the presence of adult spinal deformity. Spine 31:S139–S143. doi:10.1097/01.brs.0000231964.43289.10

    Article  PubMed  Google Scholar 

  23. Yamada K, Matsuda H, Nabeta M, Habunaga H, Suzuki A, Nakamura H (2011) Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: a comparison between patients with and without degenerative lumbar scoliosis. Eur Spine J 20:947–953. doi:10.1007/s00586-010-1597-1

    Article  PubMed Central  PubMed  Google Scholar 

  24. Transfeldt EE, Topp R, Mehbod AA, Winter RB (2010) Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine 35:1872–1875. doi:10.1097/BRS.0b013e3181ce63a2

    Article  PubMed  Google Scholar 

  25. Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7. doi:10.3171/2010.1.focus09263

    Article  PubMed  Google Scholar 

  26. Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28:E8. doi:10.3171/2010.1.focus09282

    Article  PubMed  Google Scholar 

  27. Wang MY, Mummaneni PV (2010) Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes. Neurosurg Focus 28:E9. doi:10.3171/2010.1.focus09286

    Article  PubMed  Google Scholar 

  28. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM (2010) A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35:S322–S330. doi:10.1097/BRS.0b013e3182022e04

    Article  Google Scholar 

  29. Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22(Suppl 2):S242–S253. doi:10.1007/s00586-012-2426-5

    Article  PubMed  Google Scholar 

  30. Inoue S, Watanabe T, Hirose A, Tanaka T, Matsui N, Saegusa O, Sho E (1984) Anterior discectomy and interbody fusion for lumbar disc herniation. A review of 350 cases. Clin Orthop Relat Res (183):22–31

  31. Uribe JS, Smith DA, Dakwar E, Baaj AA, Mundis GM, Turner AW, Cornwall GB, Akbarnia BA (2012) Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers. J Neurosurg Spine 17:476–485. doi:10.3171/2012.8.SPINE111121

    Article  PubMed  Google Scholar 

  32. Kotwal S, Kawaguchi S, Lebl D, Hughes A, Huang R, Sama A, Cammisa F, Girardi F (2012) Minimally invasive lateral lumbar interbody fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech. doi:10.1097/BSD.0b013e3182706ce7

    PubMed  Google Scholar 

  33. Alimi M, Hofstetter CP, Cong GT, Tsiouris AJ, James AR, Paulo D, Elowitz E, Hartl R (2014) Radiological and clinical outcomes following extreme lateral interbody fusion. J Neurosurg Spine 20:623–635. doi:10.3171/2014.1.spine13569

    Article  PubMed  Google Scholar 

  34. Khajavi K, Shen A, Hutchison A (2015) Substantial clinical benefit of minimally invasive lateral interbody fusion for degenerative spondylolisthesis. Eur Spine J. doi:10.1007/s00586-015-3841-1

    Google Scholar 

  35. Khajavi K, Shen AY (2014) Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J 23:1215–1223. doi:10.1007/s00586-014-3246-6

    Article  PubMed  Google Scholar 

  36. Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21(Suppl 1):S37–S42. doi:10.1007/s00586-012-2217-z

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors report no conflicts of interest for the current manuscript.

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Authors and Affiliations

  1. Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, 10065, USA

    Marjan Alimi, Christoph P. Hofstetter, Eric Elowitz & Roger Härtl

  2. Department of Neuroradiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Apostolos J. Tsiouris

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  1. Marjan Alimi
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  2. Christoph P. Hofstetter
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  3. Apostolos J. Tsiouris
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  4. Eric Elowitz
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  5. Roger Härtl
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Correspondence to Roger Härtl.

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Alimi, M., Hofstetter, C.P., Tsiouris, A.J. et al. Extreme lateral interbody fusion for unilateral symptomatic vertical foraminal stenosis. Eur Spine J 24 (Suppl 3), 346–352 (2015). https://doi.org/10.1007/s00586-015-3940-z

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  • DOI: https://doi.org/10.1007/s00586-015-3940-z

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