Analysis of Temporal Changes in Dural Sac Morphology After XLIF Indirect Decompression

Area of Science:

• Spinal Surgery
• Neurosurgery
• Orthopedic Surgery

Background:

• Central lumbar spinal stenosis significantly impacts quality of life.
• Indirect decompression via XLIF is a treatment option for spinal stenosis.
• Dural sac morphology changes after XLIF require further investigation.

Purpose of the Study:

• To evaluate temporal changes in dural sac morphology following XLIF indirect decompression.
• To identify factors influencing dural sac morphological changes after XLIF.
• To assess the effectiveness of XLIF for central lumbar spinal stenosis.

Main Methods:

• Retrospective analysis of 38 patients (47 intervertebral spaces) undergoing XLIF for stenosis.
• Modified Schizas classification (m-Schizas) used to grade dural sac morphology preoperatively, immediately postoperatively, and at follow-up.
• Statistical analysis of risk factors for poor morphological improvement, including preoperative dural sac cross-section area (CSA).

Main Results:

• 80.8% of treated intervertebral spaces showed morphological improvement by final follow-up.
• Immediate postoperative improvement was observed in 21.2% of cases.
• Small preoperative dural sac CSA was a significant risk factor for poor morphological improvement (OR 1.32, P < .002).

Conclusions:

• Dural sac morphology remodels and expands over time after XLIF indirect decompression.
• XLIF can lead to significant dural sac improvement in lumbar spinal stenosis.
• Patients with severe preoperative stenosis and small dural sac CSA may experience limited morphological benefits.