Research Article: Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques

Date Published: April 3, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Luis Marchi, Leonardo Oliveira, Rodrigo Amaral, Carlos Castro, Thiago Coutinho, Etevaldo Coutinho, Luiz Pimenta.


Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total) between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3%) stand-alone levels experienced cage subsidence. Pain (VAS) and disability (ODI) improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months.

Partial Text

Intervertebral disc degeneration in the spine is natural process of aging and in many cases is asymptomatic [1]. However, low back pain (LBP) is strongly associated with lumbar disc degeneration [2]. LBP is one of the most common reasons for physician visits and loss of workplace productivity worldwide, thus the issue encompasses important clinic and socioeconomic consequences.

Data were collected through retrospective review of prospectively collected clinical and radiographic registry at a single institution. Inclusion in the current study included consecutively treated patients with degenerative disc disease presenting with discogenic low back pain without radicular symptoms, after failing at least 6 months of conservative care. Discogenic pain was assessed by clinical examination [9], such as centralization phenomenon and pain during standing, and radiological signs of degeneration [10], such as black discs and endplate modifications. Provocative discography was not routinely used in making diagnostic conclusions. Patients with idiopathic/degenerative scoliosis or grade II/III/IV spondylolisthesis were excluded from the study. A psychological screening [11] was performed preoperatively, to assess psychosocial features, patient understanding and to adapt patient expectations according to the surgical objective.

From 220 patients that underwent lateral interbody fusion for degenerative disc disease between August 2007 and December 2009, 22 (10%) patients met inclusion-exclusion criteria (mean age 57.6 years, range 32–85; mean BMI 28.9, SD 7.9; 50% female) with 28 spine levels treated. One- and two-level procedures were performed in 16 (73%) and 6 (27%) cases, respectively. Levels treated included L2-3, L3-4, and/or L4-5.

This work examined the treatment of discogenic LBP in patients with degenerative disc disease treated with a discectomy and interbody fusion via lateral access. Isolated axial low back pain rapidly resolved after surgery and disability more gradually improved, as would be expected. Radiolographic analysis revealed improvements in segmental lordosis at treated levels and a high rate of solid fusion. Additionally, few complications occurred, as would be expected using a modern minimally invasive approach, and the patients were generally treated successfully through removal of the pathological intervertebral disc and by stabilizing and fusing the level.