Lateral lumbar interbody fusion for severe degenerative lumbar spinal stenosis:clinical efficacy and indication selection
ZHOU Guangwen
JIANG Zhiye
SUN Ke
WANG Longjian
WEI Guanjie
WANG Honggang
Abstract：Objective To explore the clinical efficacy and surgical indications of lateral lumbar interbody fusion (LLIF) in the treatment of severe degenerative lumbar spinal stenosis (DLSS). Methods Clinical data of 34 patients with severe DLSS (Schizas grade C and grade D) treated with LLIF in Affiliated Hospital of Guilin Medical College from June 2020 to September 2023,were retrospectively analyzed. None of the patients had significant resting pain. Operative time,intraoperative bleeding,postoperative hospital stay and perioperative complications were recorded,clinical efficacy was evaluated using low back and leg pain visual analogue scale (VAS) score,Oswestry disability index (ODI),Japanese Orthopaedic Association (JOA) score,and Macnab clinical efficacy criteria. At the same time,preoperative and postoperative lumbar spine frontal and lateral radiographs were taken to measure the posterior intervertebral space height (PISH) and the intervertebral foraminal area (IFA). Results The procedures involved 45 segments,the operation time per segment was (67.07±13.99) min,the intraoperative bleeding volume per segment was (120.59±88.60) mL,and the postoperative hospital stay was (5.81±2.51) d. There were no serious perioperative complications. One patient with Schizas grade D complained low back pain postoperatively,and was relieved after joint process closure. No patient required second-stage direct spinal canal decompression. All patients were followed up for 6 to 33 months,with the average follow-up time of (23.0±9.0) months. Patients' low back and leg pain VAS score,ODI and lumbar JOA score at 1 week postoperatively and last follow-up were significantly improved when compared with preoperative ones,and the improvement at the last follow-up was more obvious than that at 1 week after surgery (P<0.05). According to Macnab criteria,the excellent and good rate was 91.18％,with excellent in 9 cases,good in 22 and fair in 3 cases. In addition,both PISH and IFA of the surgical segment at the last follow-up were significantly improved compared with those preoperative ones (P<0.05). Conclusion For severe DLSS patients (Schizas grade C and grade D) without significant resting pain,LLIF could achieve satisfactory short-term efficacy.
Keywords：Lumbar vertebraeSpinal stenosisDecompressionsurgicalSpinal fusionIndications
Publication Date：2024-08-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 245-251 )