The Effect on Disc Height and Sagittal Alignment in 56 Consecutive Patients Undergoing Lateral Access Surgery

Abstract

Study design: Retrospective study of 56 consecutive patients who underwent direct lateral interbody fusion. Objective: Comparison of 3 graft composites and their effect on fusion rate, and the effect of interbody graft on disc height and spinopelvic parameters. Summary of background data: The lateral approach to the spine, for spinal fusion, has gained interest from spine surgeons in recent years. The approach is less invasive, with less blood loss, decreased morbidity, and decreases length of stay in the hospital. The procedure has been shown to allow indirect decompression of the spinal canal and the intervertebral foramen. Segmental interbody arthrodesis may result in improved coronal and sagittal balance. Methods: The results of 56 consecutive patients with 108 levels of pathology were operated on between 2008 and 2014 and were subsequently reviewed. The number of levels fused, the type of graft material used, the type fixation employed, the effect on disc height, regional lordosis and spino-pelvic parameters, and the number of complications were recorded. Results: In conjunction with posterior pedicle screws BMP2 78%, Autograft/BMA 75%, DBX/BMA 82% showed no significant difference in ability to achieve fusion. Anterior plating produced a 25% fusion rate and has been abandoned. The results demonstrated significant statistical improvement of disc height, increase in segmental and regional lordosis, SVA correction, and improved PI-LL. Complications, though frequent, appear transient and usually are not apparent by 6 months. Conclusions: Direct lateral interbody fusion, though fraught with many early but temporary complications, has been found to effect indirect decompression by increasing disc height. Improved SVA, lumbar lordosis, and PI-LL difference were also noted. *Corresponding author: Donald A Deinlein, MD, Clinical Associate Professor, University of Alabama at Birmingham, 960 Faculty Office Tower, 510 20th St South, Birmingham, Alabama, USA, Tel: 205-996-7258, Fax: 205-975-4701 ReSeARch ARticLe