Introduction: While there is a plethora of literature on adjacent segment disease (ASD) following traditional arthrodesis techniques, the data on ASD following LLIF is limited. Vice versa, the surgical outcome after LLIF for the treatment of ASD remains to be elucidated. The aim of this study was to assess the surgical outcome and reoperation rate in patients who underwent single-level lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD).
Methods: In our retrospective case series, patients who had undergone single-level LLIF for ASD at two institutions (03/2006-04/2012) were included, and the medical records, operative reports, radiographic imaging studies, and office records retrospectively reviewed.
Results: Out of 523 LLIF patients, 10.1% (n=53) met the inclusion criteria of the present study, and were post-operatively followed for 16.1±9.7 months (range: 5-44). When comparing the preoperative setting with both the first and most recent follow-up, LLIF resulted in a statistically significant reduction in back pain (p<0.001, and p<0.001, respectively) and leg pain (p<0.001, and p<0.001, respectively), increase in segmental lordosis (p=0.002, and p=0.011, respectively), decrease in segmental coronal angulation (p<0.001, and p=0.002, respectively), and increase in intervertebral height (p<0.001, and p<0.001, respectively) at the surgical level. The reoperation rate related to the LLIF procedure was 20.8% (11/53), which was performed after an average of 14.6±10.1 months (range: 3.3-31.0). Nine out of 11 patients (81.8%) in the reoperation sub-cohort underwent standalone LLIF, whereas only 24 out of 42 patients (57.1%) without a reoperation underwent a standalone procedure (p=0.123).
Conclusions: LLIF is an effective surgical treatment option for ASD both with regard to the clinical and the radiographic outcome in a large proportion of cases. Although standalone LLIF is associated with a narrower spectrum of adverse effects, when compared to circumferential fusion, supplemental posterior segmental instrumentation may be necessary to increase segmental stability.
Patient Care: Better application of single-level lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD).
Learning Objectives: To learn about the efficacy and value of single-level lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD).