Predictors of indirect decompression in patients with monosegmental lumbar spinal stenosis

Objective. To identify predictors of indirect decompression of spinal nerve roots in patients with degenerative monosegmental central spinal canal stenosis in the lumbar spine after isolated direct lateral interbody fusion (XLIF).

Material and Methods. This prospective study analyzes the treatment outcomes of 80 patients with multisegmental central degenerative spinal stenosis associated with instability of the spinal motion segment. All patients underwent single-level XLIF without additional posterior fixation. Based on early postoperative data, patients were divided into groups with no positive dynamics in neurological status (n = 58) and with positive dynamics in the form of a decrease in the lower extremity pain to 1 point on the VAS (n = 22). All patients underwent preoperative MRI, MSCT, lumbar spine radiography, and VAS questionnaire survey. Postoperatively, they underwent MRI and MSCT of the lumbar spine, and VAS questionnaire survey. The prognostic significance of the studied factors for treatment outcomes was determined using logistic regression analysis.

Results. Factor analysis revealed significant prognostic factors for the effectiveness of indirect decompression of spinal nerve roots in the spinal canal after XLIF: lateral recess depth greater than 3.75 mm and body mass index greater than 35.97 kg/m². According to a single-
factor model, it was revealed that the higher Hounsfield (HU) values in the bodies of adjacent vertebrae, a lower intervertebral disc, the presence of laterospondylolisthesis, intervertebral disc degeneration (Pfirrmann grades 4, 5), endplate changes of grades 4, 5, 6 according to Toshiba Endplate Scoring (TEPS) and the clinical picture of dynamic compression are moderate prognostic factors for successful indirect decompression of the nerve roots in the spinal canal after XLIF for degenerative central stenosis associated with instability of the spinal motion segment.

Conclusion. Further studies are required to validate the identified prognostic criteria, as well as other possible prognostic indicators - the timing of bone block formation in the surgical area, the frequency of implant subsidence and its clinical significance in the long-term period, the long-term effect of indirect decompression, and the results of the ODI and SF-12 survey in the late postoperative period.

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