title: Extreme lateral interbody fusion for unilateral symptomatic vertical foraminal stenosis.
abstract: OBJECTIVE
  Asymmetric loss of disc height in adult deformity patients may lead to unilateral vertical foraminal stenosis and radiculopathy. The current study aimed to investigate whether restoration of foraminal height on the symptomatic side using extreme lateral interbody fusion (XLIF) would alleviate unilateral radiculopathy.
  
  
  METHODS
  In a retrospective study, patients with single-level unilateral vertical foraminal stenosis and corresponding radicular pain undergoing XLIF were included. Functional data (visual analog scale (VAS) for buttock, leg and back, as well as Oswestry Disability Index (ODI)) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle and regional lumbar lordosis) were collected preoperatively, postoperatively and at the last follow-up.
  
  
  RESULTS
  Twenty-three patients were included, among whom 61 % had degenerative scoliosis. History of previous surgery at the level of index was present in 43 % of patients. Additional instrumentation was performed in 91 %. The foraminal height on the stenotic side was significantly increased postoperatively (p < 0.001), and remained significantly increased at the last follow-up of 11 ± 3.7 months (p < 0.001). Additionally, VAS buttock and leg on the stenotic side, VAS back and ODI were significantly improved postoperatively and at the last follow-up (p ≤ 0.001 for all parameters). The foraminal height on the stenotic side showed correlation with the VAS leg on the stenotic side, both postoperatively and the last follow-up (r = -0.590; p = 0.013, and r = -0.537; p = 0.022, respectively).
  
  
  CONCLUSIONS
  Single-level XLIF is an effective procedure for treatment of symptomatic unilateral foraminal stenosis leading to radiculopathy. In deformity patients with radicular pain caused by nerve compression at a single level, when not associated with other symptoms attributable to general scoliosis, treatment with single-level XLIF can result in short- and mid-term satisfactory outcome.
authors.affiliation: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, 10065, USA, maa2082@med.cornell.edu.
authors.forename: Marjan
authors.initials: M
authors.lastname: Alimi
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hofstetter
authors.forename: Apostolos J
authors.initials: AJ
authors.lastname: Tsiouris
authors.forename: Eric
authors.initials: E
authors.lastname: Elowitz
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D064232:Visual Analog Scale