Lateral lumbar interbody fusion in adult spine deformity - A review of literature

Abstract

Introduction: Surgery for adult spine deformity presents a challenging issue for spinal surgeons with high morbidity rates reported in the literature. The minimally invasive lateral approach aims at reducing these complications while maintaining similar outcomes as associated with open spinal surgeries. The aim of this paper is to review the literature on the use of lateral lumbar interbody fusion in the cases of adult spinal deformity.

Methods: A literature review was done using the healthcare database Advanced Research on NICE and NHS website using Medline. Search terms were "XLIF" or "LLIF" or "DLIF" or "lateral lumbar interbody fusion" or "minimal invasive lateral fusion" and "adult spinal deformity" or "spinal deformity".

Results: A total of 417 studies were considered for the review and 44 studies were shortlisted after going through the selection criteria. The data of 1722 patients and 4057 fusion levels were analysed for this review. The mean age of the patients was 65.18 years with L4/5 being the most common level fused in this review. We found significant improvement in the radiological parameters (lordosis, scoliosis, and disk height) in the pooled data. Transient neurological symptoms and cage subsidence were the two most common complications reported.

Conclusion: LLIF is a safe and effective approach in managing adult spinal deformity with low morbidity and acceptable complication rates. It can be used alone for lower grades of deformity and as an adjuvant procedure to decrease the magnitude of open surgeries in high-grade deformities.

Keywords: Adult spine deformity; LLIF; Lateral spinal fusion; XLIF.

Fig. 1

Flow diagram of the literature search performed for minimally invasive lumbar interbody fusion and selected studies.

Fig. 2

Linear regression diagram showing inverse relationship between pre-operative lumbar lordosis (x-axis) and change in lumbar lordosis (y-axis). X-axis – lumbar lordosis, y-axis- change in lumbar lordosis.

Fig. 3

Linear regression diagram showing relationship between pre-operative segmental lordosis (x-axis) and change in segmental lordosis (y-axis). X-axis – Segmental lordosis, y-axis- change in segmental lordosis.

Fig. 4

Linear regression diagram showing positive relationship between pre-operative scoliosis (x-axis) and change in scoliosis (y-axis), indicating that correction can be achieved in severe deformities as well. X-axis –Scoliosis, y-axis- change in scoliosis.