Introduction: Lateral lumber interbody fusion (LLIF) with integrated lateral modular plate fixation (MPF) can be an advantageous technique when seeking to enhance anterior column rigidity and diminish the need for extensive posterior fixation. The aim of this analysis was to determine 1) whether MPF increases intraoperative demand and 2) whether outcomes of LLIF+MPF, supplemented with interspinous process fixation (ISPF), are comparable to those of traditional LLIF with adjunctive pedicle screw fixation (PSF).
Methods: Data was retrospectively analyzed from a prospective randomized controlled study. All subjects received single-level circumferential arthrodesis for degenerative disc disease +/- spondylolisthesis. To assess intraoperative demand, ten LLIF+MPF subjects were compared with 50 subjects whom received just a LLIF cage. Intraoperative outcomes were recorded specific to the interbody approach alone. To assess outcome performance, eight LLIF+MPF+ISPF subjects were compared to 15 LLIF+PSF subjects. ODI, SF-36, and ZCQ scores were recorded at 1.5, 3, 6, 12, 24mo. post-op. Note: Outcomes through 12mo are reported here; 24mo outcomes will be available at time of presentation. Comparative analysis (p<0.05) was performed.
Results: Intraoperative outcomes (LLIF cage vs. LLIF+MPF): Operative Time (min): 49.8 vs. 44.4; Incision Lengths (cm): 4.8 vs. 3.5; EBL (ml): 39.2 vs. 39.5; and Fluoroscopy Time (sec): 63.9 vs. 69.4. No intraoperative complications were observed in the LLIF+MPF cohort. No post-operative device related complications were observed in the LLIF+MPF+ISPF cohort. ODI change from baseline was greater for LLIF+MPF+ISPF subjects across all timepoints. ZCQ and SF-36 scores were similar between groups.
Conclusions: Intraoperative demand with LLIF+MPF is comparable to that of traditional LLIF, while outcomes with the less disruptive LLIF+MPF+ISPF technique were comparable/advantageous to that of traditional LLIF+PSF.
Patient Care: This data supports more informed decision making when considering circumferential LLIF for the degenerative spine; while also further characterizing a rather new and novel technology in MPF+ISPF.
Learning Objectives: By the conclusion of this session, participants should be able to discuss/identify…
1) Does use of LLIF+MPF increase intra-op demand?
2) Patient demographics/pathologies for which LLIF+MPF+ISPF may be advantageous
3) How do outcome trends with LLIF+MPF+ISPF compare to those of traditional LLIF+PSF?