Asian Spine J.  2019 Aug;13(4):584-591. 10.31616/asj.2018.0232.

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery

Affiliations
  • 1Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan. hirospine@gmail.com
  • 2Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Abstract

STUDY DESIGN: Prospective cohort study. PURPOSE: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. OVERVIEW OF LITERATURE: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited.
METHODS
This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score.
RESULTS
Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group.
CONCLUSIONS
Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

Keyword

Lateral interbody fusion; Indirect decompression; Neurological deterioration; Complication; Lumbar stenosis

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index
Cohort Studies
Constriction, Pathologic*
Decompression*
Diabetes Mellitus
Humans
Ligaments
Logistic Models
Orthopedics
Paralysis
Prevalence
Prospective Studies
Renal Dialysis
Risk Factors
Spinal Canal
Spinal Stenosis
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