Rodrigo Navarro-Ramirez1, Gernot Lang2, Yu Moriguchi1, Eric Elowitz1, Jose Alfredo Corredor1, Mauricio J Avila1, Alberto Gotfryd1, Marjan Alimi1, Lena Gandevia1, Roger Härtl3. 1. Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA. 2. Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA; Department of Orthopedic and Trauma Surgery, Freiburg University Medical Center, Freiburg, Germany. 3. Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA. Electronic address: roger@hartlmd.net.
Abstract
BACKGROUND: Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive treatment allowing for indirect decompression of neural elements. However, evidence regarding the influence of facet degeneration (FD) and facet tropism (FT) toward indirect decompression is lacking. The aim of the study was to evaluate whether indirect decompression is impaired by FD and FT in patients undergoing ELIF. METHODS: Thirty-seven patients undergoing ELIF were included in a retrospective study. Radiographic parameters including disk height, segmental disk angle, foraminal area, FD, FT, and clinical outcome parameters (Oswestry Disability Index and Visual Analog Scale) were measured preoperatively and postoperatively. FD and FT were correlated with radiographic and clinical outcome parameters in order to determine predictors restricting indirect decompression. RESULTS: Thirty-seven patients with a total of 74 levels were analyzed. Clinical and radiographic outcome measures including central canal area (Δ = +17.2 mm2), mean disk height (Δ = +3 mm), and foraminal area (Δ = +9.9 mm2) revealed significant improvement compared with before surgery (P ≤ 0.05). Patients with severe FD (grade 4) were more likely to have FT ≥ 12 degrees (32.3%) than patients without/mild (grades 0 and 1; 10%) or moderate FD (grades 2 and 3; 13%), P ≤ 0.05. FD and FT did not affect disk height restoration, foraminal area, canal surface area, or clinical outcome measures (P ≥ 0.05). CONCLUSIONS: Indirect decompression of neural elements in ELIF is not impaired by FD and FT are not relative contraindications in patients undergoing ELIF.
BACKGROUND: Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive treatment allowing for indirect decompression of neural elements. However, evidence regarding the influence of facet degeneration (FD) and facet tropism (FT) toward indirect decompression is lacking. The aim of the study was to evaluate whether indirect decompression is impaired by FD and FT in patients undergoing ELIF. METHODS: Thirty-seven patients undergoing ELIF were included in a retrospective study. Radiographic parameters including disk height, segmental disk angle, foraminal area, FD, FT, and clinical outcome parameters (Oswestry Disability Index and Visual Analog Scale) were measured preoperatively and postoperatively. FD and FT were correlated with radiographic and clinical outcome parameters in order to determine predictors restricting indirect decompression. RESULTS: Thirty-seven patients with a total of 74 levels were analyzed. Clinical and radiographic outcome measures including central canal area (Δ = +17.2 mm2), mean disk height (Δ = +3 mm), and foraminal area (Δ = +9.9 mm2) revealed significant improvement compared with before surgery (P ≤ 0.05). Patients with severe FD (grade 4) were more likely to have FT ≥ 12 degrees (32.3%) than patients without/mild (grades 0 and 1; 10%) or moderate FD (grades 2 and 3; 13%), P ≤ 0.05. FD and FT did not affect disk height restoration, foraminal area, canal surface area, or clinical outcome measures (P ≥ 0.05). CONCLUSIONS: Indirect decompression of neural elements in ELIF is not impaired by FD and FT are not relative contraindications in patients undergoing ELIF.
Authors: Sertac Kirnaz; Rodrigo Navarro-Ramirez; Jiaao Gu; Christoph Wipplinger; Ibrahim Hussain; Joshua Adjei; Eliana Kim; Franziska Anna Schmidt; Taylor Wong; Robert Nick Hernandez; Roger Härtl Journal: Global Spine J Date: 2020-05-28
Authors: Oded Rabau; Rodrigo Navarro-Ramirez; Mina Aziz; Alisson Teles; Susan Mengxiao Ge; Javier Quillo-Olvera; Jean Ouellet Journal: Global Spine J Date: 2020-05-28