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- Title
Intraoperative Assessment of Adjacent Segment Foraminal and Central Canal Volume Changes After Cage Implantation During Lateral Trans-Psoas Surgery (XLIF).
- Authors
Navarro-Ramirez, Rodrigo; Luís, Ana; Adjei, Joshua; Wipplinger, Christoph; Kim, Eliana; Härtl, Roger
- Abstract
Introduction: Lumbar Spinal fusion using indirect decompression through extreme lateral trans-psoas surgery (XLIF) has been one of the most popular options for spinal fusion over the past decade. This procedure is now widely used to treat not only degenerative disc disease and spinal stenosis but also adult deformity and scoliosis. Furthermore, there is no question about the clinical benefits of indirect decompression or about better radiological outcomes associated with larger and wider implants. However, with the recent introduction of novel imaging tools such as the latest generation of fan-beam intraoperative CT scanners (FBiCT), multiple questions can be further studied. For instance, what is the immediate effect of XLIF over adjacent segment volumes after cage insertion? Fan-beam iCT possesses high soft tissue resolution capacity. Using these images, we have been able to accurately assess radiological outcomes of the index level and the adjacent segment (AS) as well, making this study the first to account for the intraoperative effects of XLIF on adjacent segment foramina and central canal volumes. Materials and Methods: This study was retrospectively conducted in a single-center on patients with symptomatic single or multilevel lumbosacral degenerative disorders who underwent FBiCT-guided XLIF between 2014 and 2016. We collected information regarding: Number of patients, age at time of surgery, gender, indexed level, incidence of adjacent level degeneration (ASDeg), incidence of symptomatic disease (ASDis), time to follow-up, and bilateral foramen volume for the indexed and the adjacent segments. Results: A total of 19 patients and 21 levels were analyzed in the present study. Mean age at surgery was 69 [67-80] years; 12 patients were males (57%) and 9 were females (42.9%). BMI at surgery was 26.8 [25.2;29.3]. 47.% of the indexed levels were L3-L4; 28.6% at L2-L3; 14.3% L1-L2; and 9.5% L4-L5. Radiological Outcomes (RO): Indexed level: Central Canal Volume (CCV)Pre 1.0 cm3 [0.85 -1.37] Post 4.8 cm3 [4.01-6.23]. Right foraminal volume (RFV)Pre 0.09 cm3 [0.08-0.13] Post 0.44 cm3 [0.42-0.59]. Left foraminal volume (LFV)Pre 0.09 cm3 [0.07-0.13] Post 0.51 cm3 [0.38-0.57]. AS Above(a):aCCV Pre 4.44 cm3 [3.03-6.26] Post 1.34 cm3 [1.23 -1.93] aRFV Pre 0.44 [0.41-0.58] Post 0.11 cm3 [0.09-0.13]. bLFV Pre 0.47 cm3 [0.35-0.58] Post 0.12 cm3 [0.10-0.15]. AS Below(b):bCCV: Pre 4.28 cm3 [3.00-5.52] Post 1.10 cm3 [1.01 -1.44] bRFV: Pre 0.47 [0.41-0.66] Post 0.11 cm3 [0.09-0.14]. bLFV: Pre 0.50 cm3 [0.39-0.59] Post 0.10 cm3 [0.09-0.14]. Despite a decreasing trend on the adjacent segment volumes, there was no statistically significant difference between preoperative and postoperative. Also, there was no direct correlation between the size of the cage and the volumes recorded. Conclusions: Indirect decompression decreases central canal and foraminal volume on the adjacent segments to the indexed XLIF level. Further studies with larger samples are needed to confirm these results.
- Publication
Global Spine Journal, 2018, Vol 8, p164S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030