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. 2019 Mar 15;13(4):584-591.
doi: 10.31616/asj.2018.0232. Print 2019 Aug.

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery

Hiroaki Nakashima  1 , Tokumi Kanemura  1 , Kotaro Satake  1 , Yoshimoto Ishikawa  1 , Jun Ouchida  1 , Naoki Segi  2 , Hidetoshi Yamaguchi  2 , Shiro Imagama  2
Affiliations

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery

Hiroaki Nakashima et al. Asian Spine J. .

Abstract

Study design: Prospective cohort study.

Purpose: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation.

Overview of literature: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited.

Methods: This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score.

Results: Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group.

Conclusions: Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

Keywords: Complication; Indirect decompression; Lateral interbody fusion; Lumbar stenosis; Neurological deterioration.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Representative images of thecal sac stenosis, graded (A–C) using the modified Schizas’ classification.
Fig. 2.
Fig. 2.
Representative images of case 1 (with postoperative neurological deficit). (A) Preoperative lateral X-ray; (B) preoperative T2-weighted axial MRI; (C) preoperative axial computed tomography image at L4–5; (D) lateral X-ray after LLIF; (E) T2-weighted axial MRI after LLIF; (F) postoperative X-ray after percutaneous pedicle screw fixation. MRI, magnetic resonance image; LLIF, lateral lumbar interbody fusion.
See this image and copyright information in PMC

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