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Rate of Revision Surgery After Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Spinal Stenosis

Nemani, Venu M. MD, PhD*; Aichmair, Alexander MD*; Taher, Fadi MD; Lebl, Darren R. MD*; Hughes, Alexander P. MD*; Sama, Andrew A. MD*; Cammisa, Frank P. MD*; Girardi, Federico P. MD*

doi: 10.1097/BRS.0000000000000141
Clinical Case Series

Study Design. Retrospective case series.

Objective. To examine the reoperation rate, specifically the need for posterior decompression and/or fusion, in a cohort of patients who underwent stand-alone lateral lumbar interbody fusion for symptomatic spinal stenosis with instability or deformity.

Summary of Background Data. Lateral lumbar interbody fusion provides a minimally invasive means of achieving interbody arthrodesis and indirect foraminal decompression while avoiding the potential morbidity of traditional anterior or posterior approaches. The revision rate for formal posterior decompression after isolated lateral lumbar interbody fusion for spinal stenosis is unknown.

Methods. One hundred seventeen patients who underwent stand-alone lateral lumbar interbody fusion for symptomatic spinal stenosis with an indication for fusion were included in the analysis. Detailed demographic and intraoperative data were collected. Clinical evaluation was done both preoperatively and at the final follow-up, and radiographical evaluation was done preoperatively and with the first postoperative standing radiographs.

Results. A total of 10.3% of patients who underwent stand-alone lateral lumbar interbody fusion ultimately required revision surgery, most commonly for persistent radiculopathy and symptomatic implant subsidence. Average time to revision was 10.8 months. There was no difference in radiographical correction between patients who did and did not require revision surgery.

Conclusion. Lateral lumbar interbody fusion provides a minimally invasive means to treat lumbar spinal stenosis with an acceptable revision rate for formal posterior decompression at early follow-up.

Level of Evidence: 4

Lateral lumbar interbody fusion provides a minimally invasive means of achieving interbody fusion and indirect foraminal decompression. We show that a stand-alone procedure for symptomatic spinal stenosis with an indication for fusion increased foraminal area by 53%, and resulted in a relatively low revision rate at 10.8%.

*Hospital for Special Surgery, Weill Cornell Medical College, New York, NY; and

Department for Vascular and Endovascular Surgery, Wilhelminenspital Vienna, Vienna, Austria.

Address correspondence and reprint requests to Venu M. Nemani, MD, PhD, Hospital for Special Surgery, 535 E 70th St., New York, NY 10021; E-mail: nemaniv@hss.edu

Acknowledgment date: July 19, 2013. First revision date: November 1, 2013. Acceptance date: November 20, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

The manuscript includes unlabeled/investigational uses of the products/devices listed below and the status of these is disclosed in the manuscript: bone morphogenetic protein-2 in lateral lumbar interbody fusion (LLIF); LLIF at more than 2 levels.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties, stock/stock options and payment for development of educational presentations.

© 2014 by Lippincott Williams & Wilkins