INDIRECT DECOMPRESSION BY LATERAL FUSION: ANALYSIS OF SAGITAL ALIGNMENT

Thyago Guirelle Silva,Raphael Rezende Pratali,Luiz Pimenta,Rodrigo Augusto Do Amaral

doi:10.1590/s1808-185120212001233732

Thyago Guirelle Silva, Raphael Rezende Pratali + Show 2 more

Open Access

https://doi.org/10.1590/s1808-185120212001233732

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Abstract

ABSTRACT Objective: To verify the effectiveness of indirect decompression after lateral access fusion in patients with high pelvic incidence. Methods: A retrospective, non-comparative, non-randomized analysis of 22 patients with high pelvic incidence who underwent lateral access fusion, 11 of whom were male and 11 female, with a mean age of 63 years (52-74), was conducted. Magnetic resonance exams were performed within one year after surgery. The cross-sectional area of the thecal sac, anterior and posterior disc heights, and bilateral foramen heights, measured pre- and postoperatively in axial and sagittal magnetic resonance images, were analyzed. The sagittal alignment parameters were measured using simple radiographs. The clinical results were evaluated using the ODI and VAS (back and lower limbs) questionnaires. Results: In all cases, the technique was performed successfully without neural complications. The mean cross-sectional area increased from 126.5 mm preoperatively to 174.3 mm postoperatively. The mean anterior disc height increased from 9.4 mm preoperatively to 12.8 mm postoperatively, while the posterior disc height increased from 6.3 mm preoperatively to 8.1 mm postoperatively. The mean height of the right foramen increased from 157.3 mm in the preoperative period to 171.2 mm in the postoperative period and that of the left foramen increased from 139.3 mm in the preoperative to 158.9 mm in the postoperative. Conclusions: This technique is capable of correcting misalignment in spinal deformity, achieving fusion and promoting the decompression of neural elements. Level of evidence III; Retrospective study.

Highlights

Lumbar stenosis is a change that occurs frequently in elderly patients and a reason for surgical indication at advanced ages.[1]
The mean anterior disc height increased from 9.4 mm preoperatively to 12.8 mm postoperatively, while the posterior disc height increased from 6.3 mm preoperatively to 8.1 mm postoperatively
The procedures were performed without the occurrence of important intraoperative complications, with a mean duration of 141.5 minutes and with blood loss less than 117 cc

Summary

Introduction

Lumbar stenosis is a change that occurs frequently in elderly patients and a reason for surgical indication at advanced ages.[1] With the continuing increase in life expectancy, an increased incidence of stenosis is expected. While the exact incidence is unknown, it is estimated that lumbar stenosis affects between 3 and 12 patients out of every 100,000 inhabitants older than 65 years of age annually.[2]. Spinal stenosis results in a narrowing of the canal, resulting from degenerative changes in various elements (facet hypertrophy, bulging discs, and redundancy of the yellow ligament) that cause the neural structures to be confined by the bones of the spine and adjacent soft parts.[2] In general, the onset of symptoms is slow and gradual, they can be exacerbated by trauma and intense activity.[3,4]. Degenerative stenosis can involve the central canal, the lateral recess, the foramina, or a combination of these, the latter being the most common cause of acquired stenosis, especially affecting adults and the elderly.[1,5] Canal stenosis occurs more frequently at level L4L5, followed by L5S1 and L3L4.4 it is necessary to be aware that stenosis may be associated with secondary causes, such as disc herniation, spondylolisthesis, and Paget’s disease, which exacerbate the narrowing.[1,4]

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