Early pain relief and segmental realignment after two-stage lateral lumbar interbody fusion (LLIF) with posterior instrumentation in degenerative lumbar pathology
Neurosurg Rev. 2026 Jun 4;49(1):433. doi: 10.1007/s10143-026-04351-5.
ABSTRACT
Two-stage circumferential fusion incorporating lateral lumbar interbody fusion (LLIF) is increasingly used to treat degenerative lumbar disorders, yet evidence on perioperative safety, clinical benefit, and optimal sequencing remains limited. We evaluated clinical outcomes, radiographic realignment, perioperative morbidity, and predictors of complications in patients undergoing staged LLIF with posterior fixation. We retrospectively reviewed 20 patients (mean age 67.7 years) who underwent two-stage lumbar fusion, either LLIF followed by posterior instrumentation or vice versa. We assessed pain (NRS scale), segmental lordosis (SL), blood loss, ICU and hospital length of stay, and complications. Subgroup analysis compared LLIF-first vs. posterior-first sequencing. Logistic regression identified predictors of complications. Patients showed a median age-adjusted Charlson Comorbidity Index [ACCI] of 3.0. LLIF was performed first in 65%. Mean NRS pain scores improved from 6.5 preoperatively to 4.1 after the first stage (p = 0.006) and to 3.1 after the second (p < 0.001). Early pain relief tended to be greater with LLIF-first (ΔNRS - 2.46 vs. - 1.75). Posterior-first sequencing involved more instrumented levels (median 4 vs. 2, p = 0.014), greater blood loss (628.6 vs. 142.3 mL, p = 0.01), and longer hospitalization (18.9 vs. 10.8 days, p < 0.001). LLIF-first yielded greater intervertebral height gain (6.5 vs. 3.7 mm, p = 0.05). SL improved mainly at upper lumbar levels (+ 6.4°). ACCI was the only independent predictor of complications (OR 2.6 per point; p = 0.045). Staged lateral lumbar interbody fusion with posterior instrumentation appears to be a feasible treatment option for complex degenerative lumbar disease, associated with early pain relief and segmental alignment changes. Performing the interbody fusion as the first stage may offer potential advantages; however, these findings should be interpreted cautiously given the small sample size of our cohort.
PMID:42240749 | DOI:10.1007/s10143-026-04351-5