TY - JOUR
T1 - Indirect foraminal decompression after anterior lumbar interbody fusion
T2 - a prospective radiographic study using a new pedicle-to-pedicle technique
AU - Rao, Prashanth J.
AU - Maharaj, Monish M.
AU - Phan, Kevin
AU - Lakshan Abeygunasekara, Manil
AU - Mobbs, Ralph J.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background context: A frequently quoted advantage of anterior lumbar interbody fusion (ALIF) is indirect foraminal decompression, although there are few studies substantiating this statement. Also, there are no clinical studies using a standardized method to measure the foraminal area (FA) and the correlation with disc height (DH) parameters. This study is proposed to measure the degree of indirect foraminal decompression radiologically using a standardized method and correlate with the intervertebral disc parameters. Purpose: To standardize the foramen measurement technique. To measure indirect neural foraminal decompression in surgically operated patients after ALIF using radiographic measurement and elucidate factors affecting foraminal restoration. Study design: A prospective cohort study. Patient sample: A continuous cohort of patients undergoing ALIF surgery. Outcome measures: It included FA, foraminal height (FH), and foraminal width. Methods This is a prospective analysis of a single surgeon series of consecutive patients undergoing an ALIF from 2011 to 2013. Pre- and postoperative computed tomography scans were used to obtain a standardized foramen snapshot using the pedicle-to-pedicle (P-P) technique, and measurements were obtained using image j software. Radiologic parameters such as DH, local disc angle (LDA), and lumbar lordosis (LL) were measured using radiographs and Surgimap software. Results: One-hundred forty patients with 184 levels were operated. Anterior lumbar interbody fusion resulted in a statistically significant (p<.01) improvement in foraminal dimensions (area=67%, height=21%, and width=38%). Other parameters also significantly improved, including anterior DH (90%), posterior DH (77%), LDA, and LL (6%). Posterior DH correlated significantly with FH improvement. Statistically, the P-P technique presented with high intra- and interclass reliabilities. Conclusions: Anterior lumbar interbody fusion results in significant indirect foraminal decompression based on the new P-P technique. Posterior DH is a significant factor in the restoration of the FH.
AB - Background context: A frequently quoted advantage of anterior lumbar interbody fusion (ALIF) is indirect foraminal decompression, although there are few studies substantiating this statement. Also, there are no clinical studies using a standardized method to measure the foraminal area (FA) and the correlation with disc height (DH) parameters. This study is proposed to measure the degree of indirect foraminal decompression radiologically using a standardized method and correlate with the intervertebral disc parameters. Purpose: To standardize the foramen measurement technique. To measure indirect neural foraminal decompression in surgically operated patients after ALIF using radiographic measurement and elucidate factors affecting foraminal restoration. Study design: A prospective cohort study. Patient sample: A continuous cohort of patients undergoing ALIF surgery. Outcome measures: It included FA, foraminal height (FH), and foraminal width. Methods This is a prospective analysis of a single surgeon series of consecutive patients undergoing an ALIF from 2011 to 2013. Pre- and postoperative computed tomography scans were used to obtain a standardized foramen snapshot using the pedicle-to-pedicle (P-P) technique, and measurements were obtained using image j software. Radiologic parameters such as DH, local disc angle (LDA), and lumbar lordosis (LL) were measured using radiographs and Surgimap software. Results: One-hundred forty patients with 184 levels were operated. Anterior lumbar interbody fusion resulted in a statistically significant (p<.01) improvement in foraminal dimensions (area=67%, height=21%, and width=38%). Other parameters also significantly improved, including anterior DH (90%), posterior DH (77%), LDA, and LL (6%). Posterior DH correlated significantly with FH improvement. Statistically, the P-P technique presented with high intra- and interclass reliabilities. Conclusions: Anterior lumbar interbody fusion results in significant indirect foraminal decompression based on the new P-P technique. Posterior DH is a significant factor in the restoration of the FH.
KW - Anterior lumbar interbody fusion
KW - Disc height
KW - Fine cut CT
KW - Foramen measurement
KW - Indirect decompression
KW - P-P technique
UR - http://www.scopus.com/inward/record.url?scp=84937968891&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2014.12.019
DO - 10.1016/j.spinee.2014.12.019
M3 - Article
C2 - 25543011
AN - SCOPUS:84937968891
SN - 1529-9430
VL - 15
SP - 817
EP - 824
JO - Spine Journal
JF - Spine Journal
IS - 5
ER -