RT Journal Article
SR Electronic
T1 Comparison of Stand-Alone, Transpsoas Lateral Interbody Fusion at L3-4 and Cranial vs Transforaminal Interbody Fusion at L3-4 and L4-5 for the Treatment of Lumbar Adjacent Segment Disease
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 5056
DO 10.14444/5056
A1 Jain, Deeptee
A1 Verma, Kushagra
A1 Mulvihill, Jeffrey
A1 Mizutani, Jun
A1 Tay, Bobby
A1 Burch, Shane
A1 Deviren, Vedat
YR 2018
UL https://www.ijssurgery.com/content/early/2018/08/07/5056.abstract
AB Study Design Retrospective cohort study.Objective To compare outcomes and complications of stand-alone minimally invasive lateral interbody fusion (LIF) vs revision posterior surgery for the treatment of lumbar adjacent segment disease.Methods Adults who underwent LIF or transforaminal lumbar interbody fusion (TLIF) for adjacent segment disease were compared. Exclusion criteria: >grade 1 spondylolisthesis, posterior approach after LIF, and L5/S1 surgery. Patient demographics, estimated blood loss, hospital length of stay, complications, reoperations, health-related quality of life measures, and radiographs were examined. Data were analyzed with the χ2, Wilcoxon signed rank, and Mann-Whitney U tests. Results A total of 17 LIF and 16 TLIF patients were included. Demographics were similar. Follow up was similar (LIF: 22.9 ± 11.8 months vs TLIF: 22.0 ± 4.6 months; P = .86). The LIF patients had significantly less blood loss (LIF: 36 ± 16 mL vs TLIF: 700 ± 767 mL; P < .001) and shorter length of stay (LIF: 2.6 ± 2.9 days vs TLIF: 3.3 ± 0.9 days; P = .001). There were no intraoperative complications. Revision rate was 4 of 17 in LIF and 3 of 16 in TLIF (P = .73). Baseline health-related quality of life and radiographic measurements were similar. In both groups, back and leg pain scores significantly improved, and in LIF, the Owestry Disability Index, and EuroQol-5D significantly improved. The LIF had a significant increase in intervertebral height (LIF: 4.8 ± 2.9 mm, P < .001, TLIF: 1.3 ± 3.4 mm, P = .37), which was significantly greater for LIF than TLIF (P = .002). Similarly, LIF had a significant increase in segmental lordosis (LIF: 5.6° ± 4.9°, P < .001, TLIF: 3.6° ± 8.6°, P = .16), which was not significantly different between groups.Conclusions Patients with adjacent segment disease may receive significant benefit from stand-alone LIF or TLIF. The LIF offers advantages of less blood loss and a shorter hospital stay.Level of Evidence 3