A Randomized Controlled Trial Comparing Direct and Indirect Decompression with LLIF in Selected Patients
Objective:
To compare clinical and radiological outcomes after lateral lumbar interbody fusion (LLIF), using either direct or indirect decompression, in patients with degenerative lumbar spine diseases.
Methods:
Patients who underwent single-level LLIF were randomly assigned to two groups:
- Group D: direct decompression
- Group I: indirect decompression
Clinical outcomes were measured using:
- the Oswestry Disability Index (to assess function)
- a visual analog scale (VAS) for back and leg pain
Radiological outcomes included:
- cross-sectional area (CSA) of the thecal sac,
- disc height,
- foraminal height and area,
- fusion rate,
- segmental and lumbar lordosis.
Results:
28 patients were analyzed (14 in each group), with an average age of 66.1 years. Postoperatively, both groups showed significant improvement in all clinical parameters, with no significant differences between the groups at any time point.
All radiological outcomes were similar except the CSA increase, which was significantly greater in Group D (77.73 mm² vs. 54.32 mm²; p = 0.042).
Group I (indirect decompression) had:
- less blood loss (68 mL vs. 210 mL; p < 0.005)
- shorter surgery time (136 min vs. 182 min; p = 0.002)
Overall complication rates were similar in both groups.
Conclusion:
LLIF with indirect decompression offers equivalent clinical improvements compared to LLIF with additional direct decompression after one year of follow-up. For properly selected patients, direct decompression may not be necessary, as the ligamentotaxis effect from indirect decompression seems sufficient to relieve symptoms, while also reducing blood loss and surgery time.
source: https://www.e-neurospine.org/journal/view.php?number=1551
