{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:54:54Z","timestamp":1792623294160,"version":"4.5.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Recently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4\u20135 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4\u20135 level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4\u20135. The use of this surgical approach provides a minimally invasive solution that offers excellent arthrodesis rates as well as favorable clinical and radiological outcomes, with low rates of postoperative complications. However, adhering to the techniques of transpsoas lateral surgery, such as minimal table break, an initial look-and-see approach to the psoas, clear identification of the plexus, minimal cranial caudal expansion of the retractor, mobilization of any traversing sensory nerves, and total psoas dilation times less than 20 minutes, ensures the lowest possible complication profile for both visceral and neural injuries even in the narrow safe zones when accessing the L4\u20135 disc space in patients with degenerative spondylolisthesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.10.focus17566","type":"journal-article","created":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T03:36:42Z","timestamp":1514777802000},"page":"E6","source":"Crossref","is-referenced-by-count":49,"title":["Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4\u20135"],"prefix":"10.3171","volume":"44","author":[{"given":"Peter G.","family":"Campbell","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierce D.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Orthopedics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cavanaugh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eubulus","family":"Kerr","sequence":"additional","affiliation":[{"name":"Orthopedics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip Andrew","family":"Utter","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Frank","sequence":"additional","affiliation":[{"name":"Clinical Research, Spine Institute of Louisiana, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Stone","sequence":"additional","affiliation":[{"name":"Clinical Research, Spine Institute of Louisiana, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Spine","first-page":"314","article-title":"Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4\u20135 spondylolisthesis: clinical outcomes","volume":"19","author":"Ahmadian A","year":"2013","unstructured":"Ahmadian A, Verma S, Mundis GM Jr, Oskouian RJ Jr, Smith DA, Uribe JS: Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4\u20135 spondylolisthesis: clinical outcomes. 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Clin Spine Surg [epub ahead of print], 2017"},{"key":"b13","series-title":"J Clin Neurosci","first-page":"576","article-title":"Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease","volume":"20","author":"Johnson RD","year":"2013","unstructured":"Johnson RD, Valore A, Villaminar A, Comisso M, Balsano M: Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease. J Clin Neurosci 20:576\u2013581, 2013"},{"key":"b14","series-title":"Eur Spine J","first-page":"550","article-title":"Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion","volume":"20","author":"Kepler CK","year":"2011","unstructured":"Kepler CK, Bogner EA, Herzog RJ, Huang RC: Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. 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