Radiographic and clinical evaluation of single-level lateral interbody fusion in patients with severe stenosis analyzed using cluster analysis.

Abstract

This study was a retrospective review of patients treated in a single institution. We performed a cluster analysis of the degree of preoperative stenosis to investigate the effect of indirect neural decompression in single-level lateral lumbar interbody fusion (LLIF). Surgery is generally indicated for patients with severe stenosis. On the other hand, severe lumbar spinal stenosis is a relative contraindication to LLIF and is excluded in most studies. If LLIF, which is less invasive to treatment, can be applied to severe stenosis patients, it may help treatment. Cluster analysis classified 80 patients into 3 groups based on preoperative central canal area (CCA), preoperative canal diameter (CD), and preoperative Schizas grade: group 1 with severe stenosis (n = 43); group 2 with moderate stenosis (n = 27); and group 3 with mild stenosis (n = 10). Preoperative and immediately postoperative CCA and CD in magnetic resonance imaging were compared between groups. Disc angle (DA) and anterior, posterior, and average disc heights (AvDH) (anterior disc height, posterior disc height, average disc height AvDH) were measured using standing lateral plain radiographs. For clinical analysis, a numeric rating scale was used to evaluate clinical outcomes. DA, anterior disc height, posterior disc height, and AvDH increased significantly after the operation in all groups, but the average changes in these factors did not differ. Mean midsagittal CD and axial CCA on MRI magnetic resonance imaging increased significantly in all groups, but as with DA and DH, the changes in axial CCA and midsagittal CD did not differ between groups. The numeric rating scale score did not differ between groups at any time. The cluster analysis results suggested that postoperative changes in indirect neural decompression for severe stenosis after LLIF similar for moderate and mild stenosis and that pain did not differ according to the severity of stenosis after surgery.