gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Potential and limitations of neural decompression in extreme lateral interbody fusion – a systematic review

Meeting Abstract

  • presenting/speaker Gernot Lang - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Moritz Perrech - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Rodrigo Navarro-Ramirez - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Ibrahim Hussain - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Brenton Pennicooke - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Connor Berlin - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Farah Maryam - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Roger Hartl - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO20-83

doi: 10.3205/17dkou746, urn:nbn:de:0183-17dkou7463

Veröffentlicht: 23. Oktober 2017

© 2017 Lang et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive (MIS) technique for indirect decompression of neural elements. However, evidence regarding the success of ELIF in decompressing foraminal, lateral recesses and central canal stenosis is lacking.

The purpose of this study was to systematically review current literature on the efficiency of indirect decompression via ELIF. Thus, current clinical and radiographic outcomes of ELIF in decompressing foraminal, lateral recesses, and central canal stenosis were extracted and evaluated by means of evidence based medicine.

Methods: A systematic literature search in the PubMed, Cochrane and ScienceDirect databases was performed according to PRISM criteria (Figure 1 [Fig. 1]).

Information on study design, sample size, population, procedure, number and location of involved levels, follow-up time and complications, as well as information on conflict of interest was extracted and evaluated.

Results and Conclusion: 20 publications were selected for review including a total of 1080 patients. The majority of publications (90%) were retrospective case series. Most frequent indications for ELIF included degenerative disc disease, spinal stenosis, spondylolisthesis and degenerative scoliosis. The majority of studies revealed significant improvement in radiographic and clinical outcome after ELIF. Mean foraminal area, central canal area and subarticular diameter increased by 31.6mm2 (36%), 28.5mm2 (25%) and 0.85mm (42%), respectively. ELIF successfully improved foraminal stenosis, contradictory results were found for indirect decompression of central canal stenosis. Data on lateral recess stenosis were scarce. Modalities to assess neural decompression outcome were not standardized (i.e. MRI, CT, or radiographs). Additionally, follow-up time points for the majority of the included studies were relatively short, ranging from 5.9 to 24 months. Many studies were funded by industrial sponsors and derived from only a few centers.

Current data suggests ELIF to be an efficient technique in decompression of foraminal stenosis, achieving equivalent results as MIS transforaminal lumbar interbody fusion and anterior lumbar interbody fusion. Evidence on decompression of central canal or lateral recess stenosis via ELIF is low and results are inconsistent. Most studies are limited in study design, sample size and potential conflicts of interest. Randomized controlled trials without industrial influence and standardized radiographic outcome parameters for assessing neural decompression in ELIF are needed.