Abstract
BackgroundThere have been few comparisons between dual positions, which require a position change, and a single position, which does not require position change, and it is not clear whether there is a difference in indirect decompression achieved by the two procedures. Therefore, the purpose of this study was to compare perioperative and radiographic outcomes following lateral lumbar interbody fusion (LLIF) in two cohorts of patients who underwent surgery in a single position or dual position.MethodsThis study involved 45 patients who underwent indirect decompression at 68 levels, with LLIF and percutaneous pedicle screw (PPS) fixation for lumbar degenerative spondylolisthesis with spinal canal stenosis. Patient demographics and perioperative data were compared between two groups: patients who remained in the lateral decubitus position for pedicle screw fixation (SP group) and those turned to the prone position (DP group).ResultsA total of 26 DP and 19 SP patients were analyzed. The operation time was approximately 31 min longer for the DP group (129.7 ± 36.0 min) than for the SP group (98.4 ± 41.3 min, P < 0.01). We also evaluated the pre- and postoperative image measurements, there was no significant difference for lumbar lordosis, segmental disc angle, slipping length, and disc height between the groups. The CSA of the dural sac (DP group, from 55.3 to 78.4 mm2; SP group, from 54.7 to 77.2 mm2) and central canal diameter (DP group, from 5.9 to 7.9 mm; SP group, from 5.6 to 7.7 mm) was significantly larger after surgery in both groups. However, there were no statistically significant differences between the two groups (P = 0.684).ConclusionsSP surgery could reduce the average surgery time by about 31 min. We found that the effect of indirect decompression by SP-PPS fixation following LLIF was considered to be a useful technique with no difference in dural sac enlargement or disc angle obtained compared with DP-PPS fixation.
Highlights
There have been few comparisons between dual positions, which require a position change, and a single position, which does not require position change, and it is not clear whether there is a difference in indirect decompression achieved by the two procedures
The results showed that cross-sectional area (CSA) of the dural sac was significantly increased after surgery in both groups (DP group, from 55.3 to 78.4 mm2; SP group, from 54.7 to 77.2 mm2)
All values are in mean ± standard deviation lumbar lordosis (LL) Lumbar lordosis, segmental disc angle (SDA) Segmental Disc Angle, slipping length (SL) Slipping length, ADH Anterior Disc height, PDH Posterior Disc height, Av disc height (DH) Average Disc height, dual-position surgery (DP) dual position, SP single position radiography and magnetic resonance imaging (MRI) for patients with degenerative spondylolisthesis (DS)
Summary
There have been few comparisons between dual positions, which require a position change, and a single position, which does not require position change, and it is not clear whether there is a difference in indirect decompression achieved by the two procedures. After completion of the lateral access surgery, the patient is repositioned in the prone position for the percutaneous pedicle screw (PPS) fixation [8]. This repositioning requires a second round of preparation, draping, and room positioning, which increases the operation time and cost because of the extra use of materials. Previous study comparing lumbar spinal alignment after fusion by LLIF plus PPS fixation have reported that there were no differences in segmental lordosis and overall lordosis between patients treated using one position and two positions [9]. There have been few comparisons between dual positions, which require position change, and a single position, which does not require position change, and it is not clear whether there is a difference in indirect decompression achieved by the two procedures
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