Radiographic and Surgical Outcomes After Stand-Alone Lateral Lumbar Interbody Fusion

Lateral lumbar interbody fusion (LLIF) is increasingly being utilized in isolation to achieve a large surface-area interbody fusion with an indirect decompression for spinal stenosis. This retrospective chart review was done to determine the viability of performing stand-alone (SA) LLIF.
Forty-nine patients at least 18 years of age with minimum one-year follow-up at a single institution underwent SA-LLIF using minimally invasive surgery (MIS) approach without further posterior surgery between 2011 and 2015. One to five-level fusions were included. Retrospective review of surgical outcomes and radiographic parameters were examined preoperatively, acutely postoperatively and at 1 year postoperatively.
Forty-nine patients (102 spinal segments) underwent SA-LLIF. Fusion levels ranged from one to five with a mean of 2.1 ± 2.1. Mean blood loss was 68 ± 63.2cc and mean surgical time was 143.4 ± 66.5 minutes. Fifty-seven percent had undergone prior spine surgery unrelated to their index procedure. Complication rate was 38.9% and reoperation rate was 20.4%. No difference in complication rates was noted between constructs with three or more levels fused versus less than three levels fused. At one-year, significant improvement was noted with pelvic tilt, pelvic incidence, and lumbar lordosis.
SA-LLIF is an optional MIS treatment of stable degenerative disc disease and spinal stenosis, with good one-year correction and maintenance of radiographic parameters. With complication rate of 38.9% and reoperation rate of 20.4%, true benefit of forgoing posterior supplemental fixation may be questioned.