title: Indirect foraminal decompression after lateral transpsoas interbody fusion.
abstract: OBJECTIVE
  Lateral transpsoas interbody fusion (LTIF) permits anterior column lumbar interbody fusion via a direct lateral approach. The authors sought to answer 3 questions. First, what is the effect of LTIF on lumbar foraminal area? Second, how does interbody cage placement affect intervertebral height? And third, how does the change in foraminal area and cage position correlate with changes in Oswestry Disability Index (ODI) and 12-Item Short Form Health Survey (SF-12) scores?
  
  
  METHODS
  Included patients underwent LTIF with or without posterior instrumentation and received preoperative and postoperative CT scans. Disc heights, neural foraminal area between adjacent-level pedicles, and anteroposterior cage position were measured from sagittal CT images. Preoperative and postoperative ODI and SF-12 scores were matched with the change in foraminal area from the clinically most severely affected side for analysis of the relationship between outcomes instruments and change in foraminal area.
  
  
  RESULTS
  Average foraminal area increased by 36.2 mm(2), or 35% of the preoperative area (p < 0.01), without statistically significant differences by side, level, or anteroposterior cage position. Preoperative anterior and posterior disc heights measured 6.2 mm and 3.7 mm, respectively, compared with postoperative measurements of 9.8 mm (p < 0.01) and 6.3 mm (p < 0.01), respectively, without significant differences by level or cage position. Despite significant overall improvement in ODI and SF-12 scores, there was no correlation with foraminal area increase.
  
  
  CONCLUSIONS
  Average foraminal area increased approximately 35% after cage placement without variation based on cage position. While ODI and SF-12 scores increased significantly, there was no significant association with cage position or foraminal area change, likely attributable to the multifactorial nature of preoperative pain.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. chris.kepler@gmail.com
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Amit K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Russel C
authors.initials: RC
authors.lastname: Huang
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Meredith
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
mesh_terms: D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000601:surgery*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D019919:Prosthesis Implantation / Q000379:methods*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000601:surgery*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed