Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC

ACS Applied Electronic Materials Pub Date : 2024-03-01 DOI:10.14245/ns.2346906.453

Worawat Limthongkul, Chayapong Thanapura, Khanathip Jitpakdee, Pakawas Praisarnti, Vit Kotheeranurak, Wicharn Yingsakmongkol, Teerachat Tanasansomboon, Weerasak Singhatanadgige

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引用次数: 0

Abstract

Objective To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases. Methods Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect decompression (group I). Clinical outcomes including the Oswestry Disability index and visual analogue scale of back and leg pain were collected. Radiographic outcomes including cross-sectional area (CSA) of thecal sac, disc height, foraminal height, foraminal area, fusion rate, segmental, and lumbar lordosis were measured. Results Twenty-eight patients who met the inclusion criteria were eligible for the analysis, with a distribution of 14 subjects in each group. The average age was 66.1 years. Postoperatively, significant improvements were observed in all clinical parameters. However, these improvements did not show significant difference between both groups at all follow-up periods. All radiographic outcomes were not different between both groups, except for the increase in CSA which was significantly greater in group D (77.73 ± 20.26 mm2 vs. 54.32 ± 35.70 mm2, p = 0.042). Group I demonstrated significantly lower blood loss (68.13 ± 32.06 mL vs. 210.00 ± 110.05 mL, p < 0.005), as well as shorter operative time (136.35 ± 28.07 minutes vs. 182.18 ± 42.67 minutes, p = 0.002). Overall complication rate was not different. Conclusion Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.

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外侧腰椎椎间融合术（LLIF）是否需要直接减压？一项随机对照试验，比较直接减压和间接减压与 LLIF 在部分患者中的应用

目的比较直接减压和间接减压治疗腰椎退行性疾病患者侧腰椎椎间融合术（LLIF）后的临床和影像学效果。方法将接受单水平 LLIF 的患者随机分为两组：直接减压组（D 组）和间接减压组（I 组）。收集临床结果，包括 Oswestry 失能指数和腰腿痛视觉模拟量表。放射学结果包括椎间盘囊横截面积（CSA）、椎间盘高度、椎间孔高度、椎间孔面积、融合率、节段和腰椎前凸。结果符合纳入标准的 28 名患者符合分析条件，每组 14 人。平均年龄为 66.1 岁。术后，所有临床参数均有明显改善。不过，在所有随访期间，两组患者的改善情况均无明显差异。两组的所有影像学结果均无差异，只有 D 组的 CSA 增加明显（77.73 ± 20.26 mm2 对 54.32 ± 35.70 mm2，P = 0.042）。I 组的失血量明显更少（68.13 ± 32.06 mL vs 210.00 ± 110.05 mL，p < 0.005），手术时间也更短（136.35 ± 28.07 分钟 vs 182.18 ± 42.67 分钟，p = 0.002）。总体并发症发生率没有差异。结论 LLIF间接减压术与LLIF直接减压术在1年随访期内的临床改善效果相当。这些研究结果表明，对于合适的患者，LLIF 可能不需要直接减压，因为通过间接减压达到的韧带松弛效果似乎足以缓解症状，同时减少失血量和手术时间。

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来源期刊

ACS Applied Electronic Materials Multiple-

CiteScore

7.20

自引率

4.30%

发文量

567

期刊介绍： ACS Applied Electronic Materials is an interdisciplinary journal publishing original research covering all aspects of electronic materials. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials science, engineering, optics, physics, and chemistry into important applications of electronic materials. Sample research topics that span the journal's scope are inorganic, organic, ionic and polymeric materials with properties that include conducting, semiconducting, superconducting, insulating, dielectric, magnetic, optoelectronic, piezoelectric, ferroelectric and thermoelectric. Indexed/Abstracted： Web of Science SCIE Scopus CAS INSPEC Portico