Contralateral Radiculopathy after Minimally Invasive Oblique Lumbar Interbody Fusion

Presented at SMISS Annual Forum 2018
By Amit Jhala MS DNB
With V. Kotheeranurak , G. Lin , H. Chung , J. Hur3 , J. Kim ,

Disclosures: Amit Jhala MS DNB None V. Kotheeranurak None, G. Lin None, H. Chung None, J. Hur3 None, J. Kim B; RIWO Spine, GmbH, Elliquence, LLC,

Introduction:

Minimally invasive Oblique lumbar interbody fusion (OLIF) is now widely used for treating lumbar degenerative conditions. Contralateral radiculopathy after OLIF has been sparsely reported in the literature.

Aims/Objectives:

Retrospective assessment of contralateral radiculopathy and its probable etiology in Minimally Invasive OLIF done in patients of degenerative lumbar spine disorders.

Methods:

OLIF was carried out in 60 segments of 45 patients from May 2016 to April 2018 in patients with degenerative lumbar spine disease. There were 15 males and 30 females. Age ranged from 40- 82 years with average age of 63 years. Patients with Infection, trauma, lumbar disc prolapse, severe bony canal stenosis, listhesis grade 3 or more were excluded. Single segment fusion was done in 31, double segment fusion in 13 and 3 segment fusion in 1 patient. Diagnosis was degenerative listhesis in 31 patient, Disc degeneration in 2 patients, lytic listhesis in 3 patients, lumbar spinal stenosis in 4 patients and adjacent segment disease in 5 patients. Clinical assessment was done using modified McNab’s criteria. Radiological assessment was done on X-rays and MRI. Percentage improvement in foraminal height, disc height, segmental lordosis and spinal canal area were measured. Statistical assessment was done using paired ‘t’ test. All perioperative complications were noted. Patients with contralateral radiculopathy were assessed and reviewed for the possible mechanism.

Results:

Clinically 33 (73.33%) had excellent, 11 (24.44%) had good and 1 (2.22%) had fair outcomes. On radiological measurements, foraminal height improved by 26.27%, disc height improved by 92.1%, segmental lordosis improved by 3.4 degree and overall spinal canal area improved by 42.7%. Overall post-operative complication rate was 33% with majority of them reversible. Contralateral radiculopathy was present in 8 (17.78%) patients. 1 had neurological deficit (weakness grade 2/5). 4 patients recovered fully within 1 month. 1 patient with neurological deficit recovered partially at the follow-up of one month. 3 patients required direct decompression of the nerve root involved and resolution of symptoms postoperatively. Possible mechanisms were: fracture of the superior endplate on contralateral side during cage preparation; direct nerve root compression due to cage malposition or contralateral far disc prolapse or translational correction of spondylolisthesis & neuropraxia due to distraction.

Conclusions:

This is the largest series reported on contralateral radiculopathy in Minimal Access OLIF. Being an approach related complication; its avoidance requires careful execution of surgical steps and patient counselling.