Yingsakmongkol Wicharn, Jitpakdee Khanathip, Kerr Stephen, Limthongkul Worawat, Kotheeranurak Vit, Singhatanadgige Weerasak
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
Neurospine. 2022 Sep;19(3):805-815. doi: 10.14245/ns.2244058.029. Epub 2022 Aug 10.
No consensus criteria have been established regarding ideal candidates for indirect decompression with lateral lumbar interbody fusion (LLIF), and contributing factors of indirect decompression failure were rarely reported. We aim to investigate the success rate of indirect decompression by LLIF with proposed selection criteria and identify risk factors associated with indirect decompression failure, defined as persistent pain requiring revision with direct decompression.
Data from 191 patients undergoing LLIF were retrospectively reviewed. All the following criteria must be fulfilled: (1) dynamic clinical symptoms (pain relief in supine position), (2) presence of reducible disc height (recovered disc height in supine position), (3) no profound weakness, and (4) no static stenosis. The success rate of indirect decompression with LLIF and results after at least 1 year of follow-up were collected. Preoperative, procedure-related, and postoperative factors were assessed for their relationship with failure.
Of 191 patients,13 patients (6.8%) required additional direct decompression due to persistent pain, giving a criteria success rate of 93.2%. Factors associated with indirect decompression failure included low bone mineral density (T-score < 2.1), low reducible disc height (<13%), low postoperative disc height (< 10 mm), high-grade cage subsidence, and use of plate fixation.
We proposed patient selection criteria for indirect decompression with LLIF which had a satisfactory success rate and identified factors associated with the need for additional direct decompression. Our proposed criteria may assist selection of patients likely to achieve good results following indirect decompression with LLIF, and optimize selection based on risk factors of failure.
对于腰椎侧方椎间融合术（LLIF）间接减压的理想候选者，尚未建立共识标准，且间接减压失败的相关因素鲜有报道。我们旨在通过LLIF间接减压并采用拟定的选择标准来研究成功率，并确定与间接减压失败相关的危险因素，间接减压失败定义为持续疼痛需要行直接减压翻修术。
回顾性分析191例行LLIF患者的数据。必须满足以下所有标准：（1）动态临床症状（仰卧位时疼痛缓解），（2）存在可恢复的椎间盘高度（仰卧位时椎间盘高度恢复），（3）无严重肌无力，（4）无静态狭窄。收集LLIF间接减压的成功率及至少随访1年的结果。评估术前、手术相关及术后因素与失败的关系。
191例患者中，13例（6.8%）因持续疼痛需要额外行直接减压，标准成功率为93.2%。与间接减压失败相关的因素包括低骨密度（T值<2.1）、低可恢复椎间盘高度（<13%）、术后低椎间盘高度（<10mm）、高级别椎间融合器下沉及使用钢板固定。
我们提出了LLIF间接减压的患者选择标准，其成功率令人满意，并确定了与需要额外行直接减压相关的因素。我们提出的标准可能有助于选择LLIF间接减压后可能取得良好效果的患者，并根据失败的危险因素优化选择。
