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Papers of the Week

2020 Nov 26




Physiologic Decompression of Lumbar Spinal Stenosis Through Anatomic Restoration Using Trans-Kambin Oblique Lateral Posterior Lumbar Interbody Fusion (OLLIF): A Retrospective Analysis.


Introduction Lumbar spinal stenosis (LSS) is one of the most common indications for spinal surgery. Traditionally, decompression is achieved by removing bony and ligamentous structures through open surgery. However, recent studies have shown that symptomatic relief can be accomplished in many patients by increasing intervertebral and interpedicular height using fusion alone. In this study, we evaluate whether trans-Kambin oblique lateral lumbar interbody fusion (OLLIF) can effectively and safely relieve symptoms of LSS when an indication for fusion is present. Methods This is a retrospective single surgeon cohort study of 187 patients with LSS who underwent 189 OLLIF procedures between 2012 and August 2, 2019. Inclusion criteria for this study were age >18 years with symptoms of LSS, including pain, sensory, and motor deficits, and an additional indication for fusion, which included spondylolisthesis, degenerative disk disease, disk herniation, or scoliosis. Exclusion criteria were the bony obstruction of the approach, osteogenic spinal canal stenosis, large facet hypertrophy, and listhesis grade II or greater. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were the resolution of radiculopathy at the first follow-up visit and one year after surgery, complication rates, surgery time, blood loss, and hospital stay. Results ODI improved from 52% pre-op to 37% at the one-year follow-up. At the first follow-up, radiculopathy had resolved in 39% of patients, and 72% of patients experienced improvement of 50% or greater. One year after surgery, radiculopathy had resolved in 52% of patients and 74% experienced improvement of 50% or greater. Single-level surgeries required 56.4±21.5 minutes, with a mean hospital stay of 1.6±2.4 days. Nerve irritation occurred in 12% of patients at the first postoperative follow-up and persisted in 6.8% of patients one year after surgery. There was one case each of persistent weakness at one year, infection, and cage subsidence. Conclusion Trans-Kambin OLLIF delivers anatomic restoration of intradiscal and interpedicular distance, which results in physiologic decompression of lumbar spinal stenosis in patients undergoing lumbar fusion for degenerative or herniated disk disease, spondylolisthesis, or scoliosis. Amongst patients with LSS, OLLIF results in significant improvement of radiculopathy and patient-reported disability in the majority of patients with low rates of long-term complications. Unlike other minimally invasive surgery (MIS) fusions, OLLIF can be safely used from T12-S1.