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Clinical Trial
. 2012:2012:456346.
doi: 10.1100/2012/456346. Epub 2012 Apr 1.

Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis

Luis Marchi  1 , Nitamar Abdala, Leonardo Oliveira, Rodrigo Amaral, Etevaldo Coutinho, Luiz Pimenta
Affiliations
Clinical Trial

Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis

Luis Marchi et al. ScientificWorldJournal. 2012.

Abstract

The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6 ± 10 y/o; 73.1% female; 27.4 ± 3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.). The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P < 0.001) and was maintained through 24 months (7.1%, P < 0.001). Segmental lordosis (P < 0.001) and disc height (P < 0.001) were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17%) and 7/52 cases (13%) spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

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Figures

Figure 1
Figure 1
Clinical outcomes. (a) VAS back (columns) and legs (lines and dots) scores, all postoperative results are statistically significant compared to baseline (P < 0.05). (b) ODI scores, results are statistically significant (P < 0.05).
Figure 2
Figure 2
Subsidence occurrence at 12-month radiological assessment. Occurrence by grade: grade 0 : 55.8%, grade I : 26.9%, grade II : 11.5%, and grade III : 5.8%.
Figure 3
Figure 3
Clinical outcomes in different subsidence grade groups. VAS back in low-subsidence group (0 or I) and VAS back in mild-to-severe-subsidence group (II or III). *P = 0.045.
Figure 4
Figure 4
Case example #1. (a) Preoperative X-ray (b) 3-month X-ray (c) 12-month X-ray (d) 12-month computed tomography sagittal reconstruction.
Figure 5
Figure 5
Case example #2. (a) Preoperative X-ray (b) Preoperative MRI sagittal reconstruction (c) 12-month X-ray (d) 24-month MRI sagittal reconstruction (e) 24-month computed tomography sagittal reconstruction. Arrow shows sentinel sign around cage.
See this image and copyright information in PMC

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