Lateral Lumbar Interbody Fusion With and Without Lateral Plate: A Comparative Study of Treatment Outcomes.

Abstract

Retrospective cohort study. To compare the treatment outcomes of lateral lumbar interbody fusion (LLIF) combined with lateral plate fixation (LLIF+LP) and LLIF stand-alone (LLIF-SA). Biomechanical studies suggest that LLIF+LP provides greater biomechanical strength than LLIF-SA. However, limited clinical research has shown no significant differences in fusion and cage subsidence rates between the 2 techniques at follow-up periods longer than 1 year. This study observed the occurrence of a unique fusion pattern, EVB, during the early postoperative period. The study included 57 patients in the LLIF-SA group (88 levels) and 68 patients in the LLIF+LP group (110 levels). The outcomes assessed included patient-reported outcomes, cage subsidence rates, fusion rates, lateral cage migration (LCM), and the incidence of EVB at various postoperative time points. At 6 months postoperatively, the incidence of EVB significantly differed between the 2 groups: 44.9% in the LLIF+LP group and 27.7% in the LLIF-SA group (P<0.05). However, no significant differences were observed at 3 months and 12 months postoperatively (P>0.05). At the end of the follow-up period, the overall fusion rate was comparable between the groups: 98.1% for LLIF+LP and 97.6% for LLIF-SA (P>0.05). No statistically significant difference was found in overall cage subsidence rates, but a significant difference was observed in severe subsidence rates: 27.3% in the LLIF-SA group versus 15.5% in the LLIF+LP group (P<0.05). The LCM rates were 6% in the LLIF-SA group and 0% in the LLIF+LP group (P<0.05). Both surgeries yielded satisfactory treatment outcomes. The addition of a lateral plate reduced severe subsidence and lateral migration rates of the cage. While lateral plate fixation did not significantly affect long-term fusion rates, it showed superior fusion advantages in the early postoperative period (6 mo).