Reoccurring radicular pain related with shifting overlong articular process following oblique lumbar interbody fusion: a case report
10.3760/cma.j.cn121113-20230411-00227
- VernacularTitle:OLIF术后过长关节突移位压迫神经根再发下肢痛一例报告
- Author:
Shijie LIU
1
;
Feijun LIU
;
Dengwei HE
Author Information
1. 温州医科大学附属第五医院骨科，丽水 323000
- Keywords:
Lumbar vertebrae;
Spinal fusion;
Postoperative complications;
Radiculopathy;
Articular process
- From:
Chinese Journal of Orthopaedics
2023;43(17):1174-1177
- CountryChina
- Language:Chinese
-
Abstract:
The oblique lumbar interbody fusion (OLIF) procedure has yielded favorable outcomes for individuals afflicted with degenerative lumbar conditions; however, certain complications warrant attention. We present a case of a 48-year-old female experiencing recurrent radicular pain post-OLIF. This patient, who endured persistent lower back discomfort for a decade, underwent MRI scans which revealed an intervertebral disc herniation at the L 4, 5 level and L 4 spondylolisthesis. The length of the right upper articular process of L 5 was 10.46 mm, and the distance between right upper articular process of L 5 and right nerve root of L 4 was 1.34 mm. Subsequent to OLIF, she reported recurrent radicular pain in her right leg. Post-operative CT scans revealed that the inclination of the right upper articular process of L 5 augmented from 59.46° to 65.22°. The distance from this process to the anterior foramen wall diminished from 0.63 mm to 0.25 mm, while its distance from the superior wall expanded from 0.31 mm to 0.39 mm. Furthermore, the foraminal cross-sectional area decreased from 0.29 mm 2 to 0.18 mm 2, and the lordotic angle of the intervertebral space amplified from 0.52° to 7.33°. Such measurements suggest that following OLIF, there was asymmetric retraction of the intervertebral space, accompanied by an anteroinferior tilt of the upper articular process, leading to persistent nerve root compression and thus necessitating immediate surgical nerve root decompression. This paper also elucidates the influence of the anatomical characteristics of the facet joint or articular process on lumbar functionality. Consequently, it could be postulated that hypertrophic or aberrantly elongated articular processes might induce nerve root compression due to intervertebral space retraction post-OLIF. Hence, spine surgeons should diligently assess and recognize the ramifications of such anomalies on OLIF surgical outcomes.
