• Hao Wu, Zhi Shan, Teng Zhang, Junhui Liu, Shunwu Fan, Fengdong Zhao, and CheungJason Pui YinJPYDepartment of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong. Electronic address: cheungjp@hku.hk..
• Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong.
• World Neurosurg. 2022 Nov 1; 167: e1032e1044e1032-e1044.

Objective1) To investigate if implant-related factors such as cage size and cage position are associated with radiologic improvement after indirect decompression with oblique lateral interbody fusion (OLIF). 2) To investigate the risk factors associated with indirect decompression failure (IDF) at the surgical levels after OLIF.MethodsFrom February 2015 to December 2019, 92 consecutive patients (188 levels) with lumbar spinal stenosis who underwent indirect decompression via OLIF with or without posterior instrumentation were studied retrospectively. Radiographic variables were measured preoperatively and postoperatively. The radiographic results were compared for cages with different heights and positions. IDF was defined as revision surgery within 6 months or persistent compressive symptoms 6 months after surgery.ResultsPostoperative improvements were observed in all measured radiographic parameters except for segmental lordosis. Taller cages were associated with more shrinkage of the bulging disc and greater increase in dural sac diameter. Cages placed posteriorly showed larger postoperative subarticular diameters. Twelve patients (16 levels) had IDF. Multivariate logistic regression showed that after adjusting for age, sex, and body mass index, smaller preoperative dural sac cross-sectional area and anterior positioning of cages were both independent risk factors for IDF.ConclusionsOLIF is an effective procedure for indirect decompression. To avoid reoperation for lumbar spinal stenosis, surgeons should aim to place the center of the cage at the posterior half of the lower endplate. Surgical levels with a preoperative dural sac cross-sectional area <44 mm2 may not be suitable for indirect decompression.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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