Renjie Peng

Retrospective study. To assess the revision rate of lateral lumbar interbody fusion (LLIF) with lateral plate fixation (LLIF+LP) and to evaluate the preoperative radiological parameters associated with the need for revision. LLIF is a minimally invasive option that provides indirect decompression and favorable fusion rates; however, stand-alone LLIF has been associated with substantial early revision rates. The addition of lateral plate fixation (LLIF+LP) enhances segmental stability, yet the predictors of revision following LLIF+LP remain poorly defined. Patients who underwent LLIF+LP were categorized into two groups: non-revision and revision. Central canal stenosis, lateral recess stenosis, foraminal stenosis, facet joint degeneration, endplate Modic changes, ligamentum flavum hypertrophy (>4 mm), and fat infiltration (FI) grade of the lumbar multifidus muscle were evaluated. Clinical efficacy was determined using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, assessed both preoperatively and at the final follow-up. A total of 163 patients were included in the study, consisting of 144 in the non-revision group and 19 in the revision group, yielding an overall revision rate of 11.7% (19/163). Univariate and multivariate logistic regression analyses demonstrated that ligamentum flavum hypertrophy and the FI grade of the lumbar multifidus muscle were significantly associated with the revision rate (p0.05). LLIF+LP surgery yields favorable outcomes for lumbar degenerative diseases with a low reoperation rate. Preoperative evaluation of ligamentum flavum hypertrophy and the FI grade of the lumbar multifidus muscle may assist in guiding surgical planning, preoperative discussions, and management of patient expectations.

Retrospective study. To investigate the diagnostic utility of anterior epidural fat (EF) for distinguishing isthmic from degenerative lumbar spondylolisthesis. Isthmic and degenerative lumbar spondylolisthesis must be distinguished accurately for appropriate clinical decision making. However, magnetic resonance imaging (MRI) often fails to detect pars defects; thus, additional imaging markers are needed. We retrospectively analyzed lumbar spondylolisthesis in 274 patients, of whom 129 had isthmic disease and 145 had degenerative disease. We assessed the presence and structure of anterior EF on midsagittal MRI, calculated diagnostic performance metrics, and used multivariable logistic regression to identify independent predictors of isthmic spondylolisthesis. Anterior EF was observed in 95.3% of isthmic cases and 28.3% of degenerative cases (p <0.001). As a diagnostic marker, anterior EF had 95.3% sensitivity and 71.7% specificity, and the area under the receiver operating characteristic curve indicated excellent discriminative ability. Morphologically, acute triangular anterior EF was significantly more common in patients with isthmic disease (75.2%) than in those with degenerative disease (17.2%). Multivariable analysis confirmed anterior EF as a strong independent predictor (odds ratio, 38.730; p <0.001). Anterior EF is an MRI feature that is highly sensitive and moderately specific for identifying isthmic spondylolisthesis. Its presence and characteristic acute triangular structure are valuable ancillary signs that are useful in early, noninvasive diagnosis.