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- Title
Fallen From Height but Favourable Function? A Two Year Prospective Outcome Study on Extreme Lateral Lumbar Inter-Body Fusion and Foramina Heights.
- Authors
Keng Meng Jeremy Goh; Ming Han Lincoln Liow; Sheng Xu; Marcus Ling; William Yeo; Chang Ming Guo
- Abstract
Introduction: Extreme Lateral Inter-body Fusion (XLIF) is a minimally invasive (MIS) lateral access surgical technique used in the treatment of adult spinal deformity. Cage subsidence has been widely described in lumbar inter-body fusion procedures and may theoretically diminish the potential indirect decompression benefit through associated neuroforamina narrowing. However, the relationship between postoperative neuroforaminal height maintenance and Health-related Quality-of-Life (HRQoL) measures remains unclear. Objectives: The aim of this study is to determine if changes in neuroforaminal height affects patient outcomes and HRQoL at 2 year follow-up. Material and Methods: From Aug 10 to Nov 14, 45 patients with adult spinal deformity (13 male:32 female, mean age 65 ± 6.6 years) were prospectively recruited and underwent XLIF by a single surgeon. Mean foramina height improvements postoperatively and foramina height maintenance at 2 years were recorded. The cohort was divided into 2 groups, namely (1) maintenance and (2) reduction in foramina height. All patients were assessed pre- and post-operatively (6 months, 1 year and 2 years) with numerical pain rating scale (NPRS back and leg pain), Oswestry Disability Index (ODI), Short-form 36 scores (SF-36) and the North American Spine Society (NASS) score for neurogenic symptoms (NS) and patient-rating for overall result of surgery and expectations met for surgery. Radiological fusion was assessed with the Bridwell fusion classification. Results: All patients had a minimum of two years follow-up. The average pre-op mean foramina height was 16.9 ± 3.5 mm and the average post-op foramina height was 20.1 ± 3.4 mm. Of the 45 patients, 25 showed maintenance of foramina height at 2 years postoperatively whilst 20 patients had a decrease in foramina height. There was no difference in Bridwell fusion grade between groups, with all patients achieving Grade 1 fusion at 2 years. When comparing the PROM/HRQoL outcomes for the 2 groups, there was no significant difference in NPRS, ODI, NASS-NS or SF-36 scores (p > 0.05). In addition, there was no significant difference in the physical and mental component scores of SF-36. 92% of the group 1 and 85% of group 2 patients reported good/excellent satisfaction and attained fulfilment of expectations. For the overall cohort, there was significant improvement at 2 years post-op from pre-operative scores (p < 0.05) in VAS back pain (6.0 ± 3.0 to 1.8 ± 3.1), VAS leg pain (5.0 ± 4.0 to 1.3 ± 2.9), ODI (58.1 ± 17.1 to 16.5 ± 18.4), NASS-NS(43.1 ± 23.2 to 11.9 ± 17.7) and SF-36 PCS(51.3 ± 16.8 to 75.3 ± 19.1) and MCS (51.3 ± 16.8 to 75.3 ± 19.1). Conclusion: Despite an initial increase in foramina heights after XLIF, 45% (20/45) of patients had foramina height reduction at 2 years. However, foramina height reduction did not appear to affect clinical outcomes in the short-term. Future research should focus on identifying the critical foraminal height that predicts poorer outcomes in XLIF.
- Publication
Global Spine Journal, 2018, Vol 8, p164S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/2192568218771030