title: Effects of intradiscal vacuum phenomenon on surgical outcome of lateral interbody fusion for degenerative lumbar disease.
abstract: OBJECTIVE The authors investigated whether the presence of intradiscal vacuum phenomenon (IVP) results in greater correction of disc height and restoration of segmental lordosis (SL). METHODS A retrospective chart review was performed on every patient at the University of South Florida's Department of Neurosurgery treated with lateral lumbar interbody fusion between 2011 and 2015. From these charts, preoperative plain radiographs and CT images were reviewed for the presence of IVP. Preoperative and postoperative posterior disc height (PDH), anterior disc height (ADH), and SL were measured at disc levels with IVP and compared with those at disc levels without IVP using the t-test. Linear regression was used to evaluate the factors that predict changes in PDH, ADH, and SL. RESULTS One hundred forty patients with 247 disc levels between L-1 and L-5 were treated with lateral lumbar interbody fusion. Among all disc levels treated, the mean PDH increased from 3.69 to 6.66 mm (p = 0.011), the mean ADH increased from 5.45 to 11.53 mm (p < 0.001), and the mean SL increased from 9.59° to 14.55° (p < 0.001). Significantly increased PDH was associated with the presence of IVP, addition of pedicle screws, and lack of cage subsidence; significantly increased ADH was associated with the presence of IVP, anterior longitudinal ligament (ALL) release, addition of pedicle screws, and lack of subsidence; and significantly increased SL was associated with the presence of IVP and ALL release. CONCLUSIONS IVP in patients with degenerative spinal disease remains grossly underreported. The data from the present study suggest that the presence of IVP results in increased restoration of disc height and SL.
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida; and.|Department of Neurological Surgery, University of Virginia Heath System, Charlottesville, Virginia.
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida; and.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Beckman
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida; and.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Vivas
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida; and.
authors.forename: Konrad
authors.initials: K
authors.lastname: Bach
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida; and.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery; D016014:Linear Models; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D065289:Pedicle Screws; D011379:Prognosis; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
keywords: ADH = anterior disc height; ALL = anterior longitudinal ligament; IVP = intradiscal vacuum phenomenon; LLIF = lateral lumbar interbody fusion; MIS = minimally invasive surgical; PDH = posterior disc height; SL = segmental lordosis; adult spinal deformity; degenerative disc disease; lateral lumbar interbody fusion; scoliosis; spondylolisthesis; vacuum phenomenon