Lateral Lumbar Interbody Fusion and in Situ Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine

• Published in: Journal of Korean Neurosurgical Society Vol. 60; no. 6; pp. 755 - 762
• Main Authors: Choi, Young Hoon, Kwon, Shin Won, Moon, Jung Hyeon, Kim, Chi Heon, Chung, Chun Kee, Park, Sung Bae, Heo, Won
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Neurosurgical Society 01.11.2017; 대한신경외과학회
• Subjects: Technical Note; 신경외과학; Reoperation; Minimally invasive surgical procedures; Spinal stenosis; Spinal fusion
• ISSN: 2005-3711; 1598-7876
• DOI: 10.3340/jkns.2017.0606.003

The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved ( <0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. This study demonstrates that LLIF and lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.