Are Locked Facets a Contraindication for Extreme Lateral Interbody Fusion?

Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive treatment allowing for indirect decompression of neural elements. However, evidence regarding the influence of facet degeneration (FD) and facet tropism (FT) toward indirect decompression is lacking. The aim of the study was to evaluate whether indirect decompression is impaired by FD and FT in patients undergoing ELIF.

Thirty-seven patients undergoing ELIF were included in a retrospective study. Radiographic parameters including disk height, segmental disk angle, foraminal area, FD, FT, and clinical outcome parameters (Oswestry Disability Index and Visual Analog Scale) were measured preoperatively and postoperatively. FD and FT were correlated with radiographic and clinical outcome parameters in order to determine predictors restricting indirect decompression.

Thirty-seven patients with a total of 74 levels were analyzed. Clinical and radiographic outcome measures including central canal area (Δ = +17.2 mm²), mean disk height (Δ = +3 mm), and foraminal area (Δ = +9.9 mm²) revealed significant improvement compared with before surgery (P ≤ 0.05). Patients with severe FD (grade 4) were more likely to have FT ≥ 12 degrees (32.3%) than patients without/mild (grades 0 and 1; 10%) or moderate FD (grades 2 and 3; 13%), P ≤ 0.05. FD and FT did not affect disk height restoration, foraminal area, canal surface area, or clinical outcome measures (P ≥ 0.05).

Indirect decompression of neural elements in ELIF is not impaired by FD and FT are not relative contraindications in patients undergoing ELIF.