J Korean Neurosurg Soc.  2017 Nov;60(6):755-762. 10.3340/jkns.2017.0606.003.

Lateral Lumbar Interbody Fusion and in Situ Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

• Choi YH
• Kwon SW
• Moon JH
• Kim CH
• Chung CK
• Park SB
• Heo W

• KMID: 2395797
• DOI: http://doi.org/10.3340/jkns.2017.0606.003

Abstract

OBJECTIVE
The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease.
METHODS
The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.
RESULTS
The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients.
CONCLUSION
This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

Keyword

Spinal fusion; Spinal stenosis; Minimally invasive surgical procedures; Reoperation

MeSH Terms

Constriction, Pathologic*
Follow-Up Studies
Humans
Leg
Minimally Invasive Surgical Procedures
Reoperation
Retrospective Studies
Spinal Fusion
Spinal Stenosis
Spine*
Thigh

Figure

• 

  Fig. 1 Radiological measurements. A: The sagittal vertical axis (SVA) is the horizontal distance from the C7 plumb line to the posterior-superior corner of S1. Lumbar curvature (LL) and thoracic kyphosis (TK) were measured between the superior endplate of T12 and S1 and between T5 and T12, respectively, via Cobb’s method using whole spine lateral radiographs. Pelvic parameters were measured using the measurement tools included in the picture archiving and communication system. B: The segmental angle (SA) was measured between the superior endplates of the fused segment via Cobb’s method. The anterior disc height (A) and the posterior disc height (B) on plain radiographs were measured to calculate the actual anterior (AH) and posterior disc height (PH). The length of the superior endplate of the L5 vertebra was measured on the plain radiographs (C) and computed tomography scans (C′). The actual length of the anterior disc and the posterior disc were calculated using the following formula: AH=A×(C′/C); PH=B×(C′/C). PI: pelvic incidence, SS: sacral slope, PT: pelvic tilt.

• 

  Fig. 2 Surgical procedures. A: An intraoperative fluoroscopic image shows that the bone biopsy needle is inserted into the rostral vertebra, and a guide wire is inserted along the needle. The radiolucent tubular retractor shows that the procedure was performed along the same trajectory as the lateral lumbar interbody fusion. B: The pilot hole was constructed using a tapper along the guide wire. The second pilot hole in the caudal vertebra was made after the insertion of the guide wire through the hole created by the stability pin. C: Insertion of screws/rod. D: Assembly of set screws, compression of the screws and final tightening may be facilitated using a percutaneous pedicle screw fixation system. E: The screw was inserted from the left side in the anterior 1/3 of the vertebra, and the distal end reached the contralateral vertebral cortex. The screw was inserted anterior to the psoas muscle (white line) in this example. F: Solid bony fusion occurred at 6 months postoperatively. Note the location of the lateral screws.

• 

  Fig. 3 Changes in leg pain and radiological parameters. The graphs show that during the first 3 postoperative months, leg pain decreased, and the segmental angle (SA) and anterior disc height (AH) increased. Radiological changes were not evident thereafter. mo: month, VAS-L: visual analogue pain score for the leg.

Reference

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