Mini-open lateral-anterior lumbar interbody fusion for lumbar spinal degeneration diseases: short-term results and perioperative complications

English Keywords:Lateral-anterior lumbar interbody fusion  Lumbar degenerative disease  Mini-open  Therapeutic effect  Complication

English Abstract:

  【Abstract】 Objectives: To evaluate the short-term clinical outcomes and complications of mini-open lateral-anterior lumbar interbody fusion(LaLIF) for lumbar spinal degeneration disease. Methods: From April 2016 to May 2017, total of 63 patients(94 levels) with lumbar spinal degeneration disease underwent LaLIF surgery in our hospital were reviewed. There were 23 males and 40 females, with an average age of 61±15 years old (range, 42-86 years). The diagnosis included lumbar spinal stenosis in 40 cases, lumbar spondylolisthesis in 7 cases, adult degenerative scoliosis in 8 cases, lumbar disc herniation in 8 cases. The fusion level included single level in 38 cases, double levels in 20 cases, three levels in 4 cases, four levels in 1 case, a total of 94 surgical fusion levels. The segmental distribution included L1/2 in 3 cases, L2/3 in 7 cases, L3/4 in 31 cases, L4/5 in 53 cases. 56 cases did not perform posterior internal fixation. 7 patients accepted second stage posterior fixation, including 2 unplanned posterior operation, among them 1 case of degenerative lumbar spinal stenosis plus posterior fixation due to intraoperative endplate injury and 1 case of lumbar intervertebral disc protrusion due to cage subsidence and dissatisfaction with symptomatic relief. 5 cases of degenerative lumbar scoliosis plus planned posterior internal fixation with or without decompression. The operation time, blood loss and postoperative complications were recorded. Visual analog scales(VAS) and Oswestry disability index(ODI) were assessed at preoperation and 1 month, 3 months and last follow-up after operation. SF-36 score, intervertebral disc height(DH), intervertebral foramen height(FH) and foramen area(FA) on X-ray were measured at preoperation and final follow-up. Results: 63 patients completed follow-up. The average time of follow-up was 6.0±1.2 months. The mean operation time and blood loss were 81±12min and 30±10ml of 1 level, 130±21min and 50±12ml of 2 levels, 198±25min and 150±20ml of 3 levels, 220min and 300ml of 4 levels respectively. Intraoperation complications included vein injury in 1 case, peritoneal injury in 1 case, endplate lesions in 2 cases. In the postoperation, 1 case incision appeared inflammatory edema and relieved after symptomatic treatment, 4 cases had transient pain in the front of legs and disappeared in 1 month, 1 case had lower limbs weakness and relieved after 8 weeks. In the postoperative follow-up, cage sunk(total 3 levels) was found in 2 cases, cage lightly shifted in 8 cases. No case needed revision surgery due to internal plant failure, important viscera injury, infection and so on. Compared to preoperation, the mean VAS scores and ODI of 1 month, 3 months and last follow-up after operation were improved significantly(P<0.05), and at last follow-up, SF-36 scores, DH, FH and FA on X-ray were increased significantly(P<0.05). Conclusions: Mini-open LaLIF is a minimally invasive lumbar fusion surgery. Due to less traumatic, less bleeding, short operation time and less complications in the perioperative period, LaLIF has a good application value in the treatment of lumbar degenerative disease. If surgical indications are selected strictly, stand alone LaLIF can achieve good clinical outcomes without the posterior internal fixation.