MULTICENTER ANALYSIS OF THE RESULTS OF APPLICATION OF DIRECT LATERAL INTERBODY FUSION (DLIF) AND TRANSCUTANEOUS TRANSPEDICULAR FIXATION IN PATIENTS WITH DEGENERATIVE DISC DISEASES OF THE LUMBAR SPINE

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Abstract

Background: The technique of lateral lumbar interbody fusion for the surgical treatment of patients with degenerative diseases of the lumbar spine was developed in the early 2000s. But at the same time in modern literature there is no uniform approach to the use this technique, clinical outcomes and radiological findings are contradictory.

Aims: to conduct a multicenter analysis of clinical outcomes and instrumental data of direct lateral interbody fusion (DLIF) approach combined with transcutaneous pedicle fixation in patients with single-level degenerative disc diseases of the lumbar spine.

Materials and methods: The study included 103 patients (63 men and 40 women, mean age 45.8±9.7 years) who underwent surgery followed by DLIF transcutaneous pedicle fixation. The surgery was performed at neurosurgical and vertebrological departments in Irkutsk (Russia), Omsk (Russia), and Astana (Kazakhstan). Dynamic observation and comprehensive clinical and instrumental evaluation of the treatment results were carried out for an 18-month period after surgery.

Results: After the simultaneous decompressive-stabilizing intervention, in all patients we detected a decrease in the severity of pain syndrome on VAS — from 6.9±1.6 to 1.7±1.2 cm (p<0.001), and improved quality of life index (Oswestry) — from 21.3±6.8 to 12.3±4.4% (p<0.001). The instrumental methods of examination determined the effective indirect decompression: an increase in the size of interbody gap in the middle of its department compared with the preoperative value from 8.6±3.1 to 15.7±4.2 mm (p<0.001) and an increase in the area of the intervertebral foramen (on the left with an average of 98.7±32.3 and 156.8±45.1 mm2, p<0.001; on the right —99.7±37.3 to 153.4±38.7 mm2, p<0.001). We also registered the restoration of both the segmental (from 10.2±3.8 to 13.6±6.7°, p<0.001) and regional (from 32.8±5.9 to 48.2±7.3°, р<0.001) lumbar lordosis. Complete interbody fusion was diagnosed in 87 (86.4%) patients. Complications were observed in 8.7% of cases. 

Conclusions: DLIF technique combined with transcutaneous transpedicular stabilization has high clinical efficacy confirmed by significant reduction in the severity of pain according to VAS. The studied approach improves the quality of life of patients by Oswestry index and reveals a low number of postoperative complications. The described simultaneous minimally invasive method of surgical treatment in patients with degenerative disc diseases allows to restore the sagittal profile of the lumbar spine and implement an effective stabilization of the operated vertebral-motor segments with a high degree of formation of interbody bone block.

About the authors

V. A. Byvaltsev

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.; Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Academy of Postgraduate Education

Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101

MD, chief neurosurgeon of JSC "Russian Railways" Department of Health, the head of neurosurgery Road Clinical Hospital Center in the art. Irkutsk-Passenger JSC "Russian Railways", the head of the course of neurosurgery of the Irkutsk State Medical University, Head of the Scientific-clinical department of orthopedics and neurosurgery of the Irkutsk Scientific Center of Surgery and Traumatology, Professor, Department of traumatology, orthopedics and neurosurgery of the Irkutsk State Medical Academy of Postgraduate Education

 

Russian Federation

A. A. Kalinin

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.; Irkutsk Scientific Center of Surgery and Traumatology

Author for correspondence.
Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0001-9039-9147

PhD, associate professor of the course of neurosurgery of the Irkutsk State Medical University, neurosurgeon Neurosurgery Center Road Clinical Hospital Art. Irkutsk-Passenger JSC "Russian Railways"

 

Russian Federation

S. K. Akshulakov

National Centre of Neurosurgery

Email: raim@rambler.ru
ORCID iD: 0000-0003-1781-6017

Corresponding Member of the National Academy of Sciences of Kazakhstan, Professor, Chairman of the Board of JSC "National Centre for Neurosurgery" in Astana

 

Kazakhstan

A. E. Krivoshein

Omsk State Medical University; Clinical medical-surgical center

Email: artem.krivoschein@yandex.ru
ORCID iD: 0000-0003-2633-7149

PhD, Assistant of the Department of Traumatology and Orthopedics FGBOU IN "Omsk State Medical University" , doctor traumatologist department vertebrology Buso "Clinical Medical and Surgical Center" in Omsk

 

Russian Federation

T. T. Kerimbayev

National Centre of Neurosurgery

Email: kerimbaev_t@mail.ru
ORCID iD: 0000-0002-0862-1747

MD, head of spinal neurosurgery and pathology of the peripheral nervous system of JSC "National Centre for Neurosurgery" in Astana

 

Kazakhstan

I. A. Stepanov

Irkutsk State Medical University

Email: edmoilers@mail.ru
ORCID iD: 0000-0001-9039-9147

post-graduate course of neurosurgery

 

Russian Federation

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