Far Lateral Lumbar Decompression Using the Far-Lateral Approach

Abstract

Study Design. Single centre retrospective study of prospectively collected data. Objective. Analyse factors associated with patient reported outcome after far lateral decompression surgery (FLDS) for lumbar nerve root compression using the far-lateral approach. Summary of Background Data. To date, no studies have investigated the influence of vertebral level, coronal segmental Cobb angle, and the nature of the compressive tissue (hard/soft) on patient reported outcome following FLDS. Methods. Patients who had undergone FLDS between 2005 and 2020 were included. Coronal segmental angle (CSCA) was measured on preoperative, posteroanterior radiographs. Primary outcome measure was the Core Outcome Measures Index (COMI) score at 2 years’ follow-up (2Y-FU). Patients who had undergone microsurgical decompression using a midline approach (MID) served as a comparator group. Results. There were 148 FLDS and 463 MID patients. In both groups there was a significant improvement in COMI score from preoperative to 2Y-FU (P<0.0001), with greater improvement in patients treated at higher vertebral levels than in those treated at L5/S1 (P=0.014). Baseline COMI, ASA grade, BMI, and low back pain as the “chief complaint” all had a significant association with the 2-year COMI score. The nature of compressive tissue showed no association with COMI score at 2Y-FU. In the FLDS group, there was a statistically significant correlation between the preoperative CSCA and change in COMI score preoperatively to 2Y-FU (P<0.001). The association was retained in multiple regression analysis controlling for confounders. A one-degree increase in CSCA was associated with a 0.35-point worse COMI score at 2Y-FU (P=0.003). Conclusion. Treatment of far lateral nerve root compression showed overall good patient reported outcome, but with less improvement with advanced coronal segmental angulation. Modified approaches and techniques might be preferable for the level L5/S1.