title: Lateral lumbar interbody fusion for the correction of spondylolisthesis and adult degenerative scoliosis in high-risk patients: early radiographic results and complications.
abstract: BACKGROUND
  Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients.
  
  
  METHODS
  We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion.
  
  
  RESULTS
  Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon.
  
  
  CONCLUSIONS
  Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates.
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Brad
authors.initials: B
authors.lastname: Waddell
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: David
authors.initials: D
authors.lastname: Briski
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Rabah
authors.initials: R
authors.lastname: Qadir
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Godoy
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Allison Howard
authors.initials: AH
authors.lastname: Houston
authors.affiliation: Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Rudman
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zavatsky
keywords: Comorbidity; lumbar vertebrae; spinal fusion; surgical procedures–minimally invasive; tomography–x-ray computed