Application of self-anchored lateral lumbar interbody fusion in lumbar degenerative diseases

Zhang et al. BMC Musculoskeletal Disorders https://doi.org/10.1186/s12891-023-06974-x (2023) 24:836 BMC Musculoskeletal Disorders Open Access RESEARCH Application of self-anchored lateral lumbar interbody fusion in lumbar degenerative diseases Kaihui Zhang1, Haiwei Xu1, Lilong Du1, Yue Liu1 and Baoshan Xu1* Abstract Study Design This is a retrospective study. Objective The aim of the study was to evaluate the efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF) in lumbar degenerative diseases. Methods Forty-eight patients with lumbar degenerative disease between January 2019 and June 2020 were enrolled in this study. All patients complained of low back and leg pain, which were aggravated during standing activities and alleviated or disappeared during lying. After general anesthesia, the patient was placed in the right decubitus position. The anterior edge of the psoas major muscle was exposed through an oblique incision of approximately 6 cm, using an extraperitoneal approach. The psoas major muscle was then properly retracted dorsally to expose the disc. After discectomy, a suitable cage filled with autogenous bone graft from the ilium was implanted. Two anchoring plates were inserted separately into the caudal and cranial vertebral bodies to lock the cage. Clinical efficacy was evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI). Lumbar lordosis, intervertebral disc height, spondylolisthesis rate, cage subsidence and fusion rate were also recorded. Results A total of 48 patients were enrolled in this study, including 20 males and 28 females, aged 61.4 ± 7.3 (range 49–78) years old. Surgery was successfully performed in all patients. Lumbar stenosis and instability were observed in 22 cases, disc degenerative disease in eight cases, degenerative spondylolisthesis in nine cases, degenerative scoliosis in six cases, and postoperative revision in three cases. In addition, five patients were diagnosed with osteoporosis. The index levels included L2–3 in three patients, L3–4 in 13 patients, L4–5 in 23 patients, L2–4 in three patients, and L3–5 in six patients. The operation time was 81.1 ± 6.4 (range 65–102) min. Intraoperative blood loss was 39.9 ± 8.5 (range 15–72) mL. No severe complications occurred, such as nerve or blood vessel injuries. The patients were followed up for 11.7 ± 2.3 (range 4–18) months. At the last follow-up, the VAS decreased from 6.2 ± 2.3 to 1.7 ± 1.1, and the ODI decreased from 48.4% ± 11.2% to 10.9% ± 5.5%. Radiography showed satisfactory postoperative spine alignment. No cage displacement was found, but cage subsidence 2–3 mm was found in five patients without obvious symptoms, except transient low back pain in an obese patient. The lumbar lordosis recovered from 36.8° ± 7.9° to 47.7° ± 6.8°, and intervertebral disc height recovered from 8.2 ± 2.0 mm to 11.4 ± 2.5 mm. The spondylolisthesis rate decreased *Correspondence: Baoshan Xu Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zhang et al. BMC Musculoskeletal Disorders (2023) 24:836 Page 2 of 11 from 19.9% ± 4.9% to 9.4% ± 3.2%. The difference between preoperative and last follow-up was statistically significant (P<0.05). Conclusion SA-LLIF can provide immediate stability and good results for lumbar degenerative diseases with a standalone anchored cage without posterior internal fixation. Keywords Self-anchored cage, Degenerative disease, Spinal fusion, Surgical procedure, Lateral lumbar interbody fusion Introduction Lumbar spinal fusion is a common treatment for a range of severe lumbar degenerative diseases, including degenerative spinal canal stenosis, instability, spondylolisthesis, and scoliosis. According to different approaches, lumbar fusion surgery can be divided into posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF) and LLIF. LLIF can be divided into direct/extreme lateral interbody fusion (D/XLIF) and OLIF [1]. PLIF involves laminectomy and decompression through the posterior approach, but the dural sac and nerve root need to be retracted for interbody fusion, which may result in severe injury. Another posterior transforaminal approach for fusion is TLIF, which can reduce the risk of nerve traction injuries. The minimally invasive approach TLIF (MIS-TLIF) further reduces tissue injury, but requires entering the spinal canal, which poses a risk for dural tear and nerve root injury and could damage the lower back muscles and destroy the posterior column structure. The pedicle internal fixation may cause adjacent segmental degeneration and low back pain [2, 3]. ALIF and LLIF can avoid lumbar muscle injury and posterior column destruction, completely remove the diseased intervertebral disc, and better restore disc height and physiological kyphosis. However, ALIF needs to distract the internal organs and separate the large ventral blood vessels, which is relatively complicated and has the possibility of sympathetic nerve injury and retrograde ejaculation [2]. Lateral lumbar interbody fusion (LLIF) has developed rapidly and received increasing attention in recent years. It is a lumbar interbody fusion technique that is performed through a small incision and extraperitoneal approach without low back muscle splitting. After the degenerative intervertebral disc is exposed and removed, instant stability is obtained when the cage is implanted laterally [4, 5]. Extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF) are the two major approaches to LLIF [1]. As transpsoas XLIF may interfere with the lumbar plexus nerve, OLIF has gained popularity because it passes through the natural gap between the psoas muscle and the abdominal aorta, which can significantly reduce the risk of nerve injury and achieve indirect decompression and red (...truncated)