Lateral lumbar interbody fusion with lateral plating: techniques, feasibility and efficacy

Area of Science:

• Spinal surgery
• Orthopedics
• Neurosurgery

Background:

• Standalone lateral lumbar interbody fusion (LLIF) offers single-position surgery but risks non-union and cage subsidence due to lack of fixation.
• Lateral plating after LLIF may mitigate these risks, yet its feasibility with a four-hole plate requires further investigation.

Purpose of the Study:

• To review techniques and evaluate the performance of LLIF with lateral plating using clinical and radiographic data.
• To assess the efficacy of a four-hole lateral plate in conjunction with LLIF.

Main Methods:

• Retrospective analysis of 55 LLIF patients with lumbar degenerative disease undergoing lateral plating.
• Exclusion of patients with significant deformity (Cobb angle > 20°, grade 2 spondylolisthesis).
• Evaluation of clinical outcomes via patient-reported outcome measures (PROMs) and radiographic outcomes (non-union, cage subsidence) via CT scans at 12 months post-surgery.

Main Results:

• A four-hole plate was successfully implanted in 65 of 77 levels; two-hole plates were used for the remainder.
• Postoperative psoas weakness (15%) and thigh/groin numbness (18%) resolved.
• Non-union occurred in 12% and low-grade cage subsidence in 21% of levels with available CT scans.
• Significant PROM improvements were observed, irrespective of non-union or subsidence, with no reoperations needed.
• Smoking and lack of bicortical screw purchase predicted cage subsidence.

Conclusions:

• A four-screw plating construct is a safe and feasible fixation method for LLIF.
• This technique demonstrates significant improvements in PROMs and favorable fusion rates.
• Low-grade cage subsidence is possible but does not appear to negatively impact clinical outcomes.
• Utilizing bicortical screws may reduce the incidence of cage subsidence.