ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Risk factors for adjacent segment disease after lateral lumbar interbody fusion for lumbar spinal canal stenosis with instability.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Is bilateral laminectomy and fusion superior to total laminectomy and fusion in two-level lumbar spinal stenosis?Frontiers in surgery · 2026Article
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
purposeLateral lumbar interbody fusion (LLIF) achieves indirect decompression by restoring disc height; however, excessive cage elevation may increase the risk of adjacent segment disease (ASD). This relationship remains unclear. Therefore, this study aimed to identify ASD risk factors following LLIF by focusing on intervertebral height gain and comparing outcomes of LLIF and decompression using propensity score matching (PSM).
methodsSeventy-six patients who underwent single-level LLIF for lumbar stenosis with instability were analyzed to identify ASD-related risk factors. Univariate and multivariate Cox regression analyses were used to determine independent predictors. A receiver-operating characteristic analysis identified the optimal cage elevation threshold. PSM of 69 patients with LLIF and 69 patients with decompression was performed. ASD-free survival was evaluated using a Kaplan-Meier analysis. The LLIF cohort was divided into low and high elevation groups based on a cutoff of 3.7 mm.
resultsA multivariate analysis identified posterior cage placement (hazard ratio [HR], 1.06; p = 0.032) and greater cage elevation (HR, 1.28; p = 0.012) as independent risk factors. The 5-year ASD-free survival rates were 81.1%, 72.9%, and 46.9% for decompression, low-elevation LLIF, and high-elevation LLIF, respectively. Compared to decompression, high-elevation LLIF significantly increased the ASD risk (HR, 3.81; p < 0.001), but low-elevation LLIF did not (HR, 1.79; p = 0.279). Low-elevation LLIF resulted in greater leg numbness improvement (16.65 vs. 41.90; p = 0.023).
conclusionExcessive intervertebral elevation with LLIF increased the ASD risk. Decompression and LLIF with moderate elevation improved symptoms without a significantly different ASD incidence.
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