Early curative effect of extreme lateral interbody fusion for the treatment of lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Lateral interbody fusion  Minimally invasive

English Abstract:

  【Abstract】 Objectives: To investigate the early curative effect of extreme lateral interbody fusion(XLIF) in the treatment of degenerative lumbar spinal stenosis. Methods: Total 41 patients who underwent XLIF surgery for degenerative lumbar spinal stenosis in General Hospital of Guangzhou Military Command from July 2012 to March 2017 were retrospectively reviewed. There were 15 males and 26 females, the mean age was 64.4±9.8(range, 39-83) years old, with a total of 51 operative segments. Clinical efficacy evaluation included VAS score, Oswestry disability index(ODI) score and JOA score of lumbar spine before surgery and at the last follow-up. Imaging evaluation included measuring the foraminal height, dics height and foraminal area on the lateral X-ray before surgery, one week after surgery, and at the last follow-up. The anterior-posterior diameter of the canal and the cross-sectional area of the canal on MRI(T2-weighted) images was measured before surgery, one week after surgery, and at the last follow-up. Patients were divided into two groups according to the internal fixation: side screw group(21 cases, 26 segments) and posterior screw group(20 cases, 25 segments). Overall data of preoperation, postoperative 1 week, and final follow-up, as well as the changes in different groups before and after surgery were compared. Results: The average operation time per segment was 92.12±45.95min(50-260min), and the average bleeding was 56.34±58.81ml(10-225ml) for each segment. 11 patients had occured transient anterolateral thigh numbness after operation, and the symptoms were relieved or disappeared gradually within 1 to 6 weeks after operation. However, there was no cerebrospinal fluid leakage, major blood vessels, abdominal organs, reproductive femoral nerves or other injuries. During follow-up, cage subsidence was found in 13 patients(31.7%), among whorm 11 were GradeⅠand 2 were Grade Ⅱ. The average follow-up time was 22.39±13.18(6-63) months. Overall, VAS score, ODI score and JOA score of lumbar spine at the last follow-up were significantly improved(P<0.05). Disc height, foraminal height, foraminal area, anterior-posterior diameter of the canal, cross-sectional area of the canal within 1 week after operation, and disc height, foraminal height, foraminal area at the last follow-up were significantly improved compared to the preoperative ones, with statistical differences(P<0.05). There were no significant differences in the values of foraminal height, disc height, foraminal area, anterior-posterior diameter of the canal and cross-sectional area of the canal between the two groups(P>0.05). At the last follow-up, the disc height and foraminal area loss in the side screw group were more than those in the posterior screw group, with statistical significance(P<0.05). Conclusions: XLIF for the treatment of degenerative lumbar spinal stenosis has a good early curative effect.