J Korean Neurosurg Soc.  2022 Jan;65(1):74-83. 10.3340/jkns.2021.0105.

Do Obliquity and Position of the Oblique Lumbar Interbody Fusion Cage Influence the Degree of Indirect Decompression of Foraminal Stenosis?

• Mahatthanatrakul A
• Kotheeranurak V
• Lin GX
• Hur JW
• Chung HJ
• Lokanath YK
• Pakdeenit B
• Kim JS

• KMID: 2523915
• DOI: http://doi.org/10.3340/jkns.2021.0105

Abstract

Objective
: Oblique lumbar interbody fusion (OLIF) is a surgical technique that utilizes a large interbody cage to indirectly decompress neural elements. The position of the cage relative to the vertebral body could affect the degree of foraminal decompression. Previous studies determined the position of the cage using plain radiographs, with conflicting results regarding the influence of the position of the cage to the degree of neural foramen decompression. Because of the cage obliquity, computed tomography (CT) has better accuracy than plain radiograph for the measurement of the obliquely inserted cage. The objective of this study is to find the correlation between the position of the OLIF cage with the degree of indirect decompression of foraminal stenosis using CT and magnetic resonance imaging (MRI).
Methods
: We review imaging of 46 patients who underwent OLIF from L2-L5 for 68 levels. Segmental lordosis (SL) was measured in a plain radiograph. The positions of the cage were measured in CT. Spinal canal cross-sectional area (SCSA), and foraminal crosssectional area (FSCA) measurements using MRI were taken into consideration.
Results
: Patients’ mean age was 69.7 years. SL increases 3.0±5.1 degrees. Significant increases in SCSA (33.3%), FCSA (43.7% on the left and 45.0% on the right foramen) were found (p<0.001). Multiple linear regression analysis shows putting the cage in the more posterior position correlated with more increase of FSCA and decreases SL correction. The position of the cage does not affect the degree of the central spinal canal decompression. Obliquity of the cage does not result in different degrees of foraminal decompression between right and left side neural foramen.
Conclusion
: Cage position near the posterior part of the vertebral body increases the decompression effect of the neural foramen while putting the cage in the more anterior position correlated with increases SL.

Keyword

Decompression, surgical; Lumbosacral region; Magnetic resonance imaging; Spinal fusion; Tomography, X-ray computed

Figure

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  Fig. 1. Radiographic measurements. A : Anterior (A) middle (M) and posterior (P) disc height and foraminal height (FH). B : Segmental lordosis (SL) and lumbar lordosis (LL). C : Coronal Cobb’s angle (CC). D : Spondylolisthesis slip percentage was calculated from slip distance divided by the width of the lower vertebral body.

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  Fig. 2. Computed tomography measurements. A : Foraminal cross-sectional area and foraminal height (FH). B : Cage distance (CDis) and cage trajectory angle (CTA).

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  Fig. 3. Magnetic resonance imaging measurements. A : Spinal canal width. B : Spinal canal cross-sectional area. C : Foraminal cross-sectional area.

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  Fig. 4. Flow chart of the patient cohort. TLIF : transforaminal lumbar interbody fusion, PLIF : posterior lumbar interbodyfusion.

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  Fig. 5. Linear regression show association between cage position and foraminal stenosis decompression (A) and segmental lordosis correction (B).

Reference

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