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Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

  • Symposium: Minimally Invasive Spine Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion.

Question/purposes

We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach.

Methods

Between 2008 and 2012, 158 patients were surgically treated to alleviate symptoms associated with degenerative lumbar stenosis, of whom 60 (38%) were treated with lateral lumbar interbody fusion. Of these 60 patients, 36 (60%) received CT scans preoperatively and at 1-year postoperatively and were available for radiographic analysis. Of the 60 treated patients, 16 (27%) were lost to followup before 12 months, leaving the records of 44 patients available for review of patient-reported improvements in pain and return to function. Radiographic increases in disc height, foraminal area, and canal area were measured by one observer on CT scans postoperatively and at 1 year and compared to preoperative values. Patient-reported scores, including VAS pain score and Oswestry Disability Index (ODI), were collected preoperatively and at 3 and 12 months postoperatively.

Results

Increases in disc height (67%, p < 0.001), foraminal area (24%–31%, p < 0.001), and canal area (7%, p = 0.011) measured immediately postoperatively were sustained at 1-year followup. VAS pain score and ODI both improved (p < 0.001) at 3 months and were maintained at 1 year. No pseudarthroses were noted radiographically.

Conclusions

The lateral transpsoas approach to interbody fusion is capable of sustaining indirect decompression of the neural structures and resolving preoperative claudication and radiculopathy. A larger series of patients with longer followup should be studied to substantiate these early clinical results.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank Deborah Warren RN, CCRP, Ann-Meredith Baldy, and Christopher Walker for their assistance with data collection and database management.

Author information

Authors and Affiliations

  1. Center for Spinal Disorders, Florida Orthopaedic Institute, 13020 North Telecom Parkway, Tampa, FL, 33637, USA

    Antonio E. Castellvi MD, Thomas W. Nienke MD & German A. Marulanda MD

  2. Departments of Radiology, Neurology and Psychiatry, University of South Florida, Tampa, FL, USA

    Ryan D. Murtagh MD

  3. Foundation for Orthopaedic Research & Education, Tampa, FL, USA

    Brandon G. Santoni PhD

Authors
  1. Antonio E. Castellvi MD
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  2. Thomas W. Nienke MD
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  3. German A. Marulanda MD
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  4. Ryan D. Murtagh MD
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  5. Brandon G. Santoni PhD
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Corresponding author

Correspondence to Antonio E. Castellvi MD.

Additional information

One of the authors certifies that he (AEC), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD (less than USD 10,000), from Crocker Spinal Technologies, Inc (Provo, UT, USA) and Nanovis, Inc (Columbia City, IN, USA); and an amount of USD (USD 10,000 to USD 100,000), from Alphatec Spine, Inc (Carlsbad, CA, USA). Each of the remaining authors certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Florida Orthopaedic Institute, Tampa, FL, USA.

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Castellvi, A.E., Nienke, T.W., Marulanda, G.A. et al. Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation. Clin Orthop Relat Res 472, 1784–1791 (2014). https://doi.org/10.1007/s11999-014-3464-6

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  • DOI: https://doi.org/10.1007/s11999-014-3464-6

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