ABSTRACT OBJECTIVE Lumbar canal stenosis associated with osteoporotic vertebral fractures (LCS-OVF) is rare, and optimal surgical strategies remain controversial. While anterior reconstruction is considered beneficial, no studies have compared lateral lumbar interbody fusion (LLIF) and extensive posterior lumbar interbody fusion (Ex-PLIF). This study compared the efficacy and safety of Ex-PLIF and LLIF for LCS-OVF. METHODS We retrospectively reviewed 40 patients from five hospitals treated between 2015 and 2022. Patients underwent 1- or 2-level Ex-PLIF (n=22) or LLIF (n=18). Assessment included demographics, activities of daily living (ADL), operative parameters, complications, and radiographic outcomes. A novel fracture classification based on coronal CT endplate morphology (asymmetry, flat, concave) was developed. RESULTS Both groups showed significant postoperative ADL improvement. Intraoperative blood loss was significantly lower in the LLIF group (p=0.004). The LLIF group also demonstrated significantly less correction loss of the local lordotic angle compared to the Ex-PLIF group (p<0.05). No significant differences in postoperative complications were observed. Regarding fracture classification, asymmetry was more frequent in the Ex-PLIF group (n=5 vs. n=1). Fixation involving L5/S1 occurred only in the Ex-PLIF group (n=4). CONCLUSIONS LLIF is superior to Ex-PLIF regarding blood loss and maintenance of sagittal correction. However, Ex-PLIF remains a viable option for patients requiring L5/S1 involvement or those presenting with asymmetric vertebral endplate morphology.
Tanaka et al. (Fri,) studied this question.