Abstract:
OBJECTIVE:Although extreme lateral interbody fusion (XLIF) largely provides successful indirect decompression, some patients have recurrent same-level pain and functional disability. Identifying risk factors for this failure would facilitate better patient selection and improve outcomes. The aim of this study is to identify preoperative radiographic risk factors for failure of XLIF. METHODS:Patients undergoing XLIF were prospectively enrolled by 3 surgeons at 3 separate institutions. Radiographic variables measured included (1) anterior and posterior disc height, (2) foramen height and area, (3) central canal diameter, (4) central canal area, (5) right and left subarticular diameters, (6) facet arthropathy grade, and (7) presence of bony lateral recess stenosis. Patients failed indirect decompression if Oswestry Disability Index (ODI) scores did not improve by 20 points or revision surgery was required within 6 months postoperatively. Univariate and multivariate analyses were performed to identify radiographic predictors of failure of indirect decompression. RESULTS:Of the 45 patients (age 65.6 ± 10.5 years; 14 male) involving 101 spinal levels included in this study, 13 (29%) failed indirect decompression. From univariate analysis, these patients had significantly smaller central canal diameter, foraminal height, and disc height (P < 0.05). In multivariate analysis of these parameters and those trending toward significance, bony lateral recess stenosis was the only significant independent predictor for failure of indirect decompression (coefficient, 0.55 [0.24-0.85]; P < 0.001). CONCLUSIONS:Bony lateral recess stenosis is an independent predictor for failure to achieve adequate spinal decompression via XLIF and thus may benefit from undergoing direct decompression.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Wang TY,Nayar G,Brown CR,Pimenta L,Karikari IO,Isaacs REdoi
10.1016/j.wneu.2017.07.045subject
Has Abstractpub_date
2017-10-01 00:00:00pages
819-826eissn
1878-8750issn
1878-8769pii
S1878-8750(17)31145-2journal_volume
106pub_type
杂志文章,多中心研究abstract:BACKGROUND:Neurosurgical spine specialists receive considerable amounts of industry support that may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy...
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