What question did this study set out to answer?

To evaluate the effectiveness and safety of multilevel lateral lumbar interbody fusion in patients with symptomatic degenerative lumbar spinal stenosis without scoliosis.

April 3, 2026The International Journal of Spine Surgery0 citationsOpen Access

Multilevel Lateral Lumbar Interbody Fusion for Symptomatic Spondylotic Stenosis and Severe Disc Degeneration Without Scoliosis: Single-Institutional Case Series and Lessons Learned

DCDerrick Chatad WDWeston C. DeLomba MTMazen Taman

Key Points

To evaluate the effectiveness and safety of multilevel lateral lumbar interbody fusion in patients with symptomatic degenerative lumbar spinal stenosis without scoliosis.
Single-institution retrospective case series from 2016 to 2022
Included adults with symptomatic spondylotic stenosis and severe disc degeneration
Primary outcomes measured were radiographic decompression, pain and disability using visual analog scale and Oswestry Disability Index
Central canal diameter increased by 31% post-surgery
Foraminal height improved by up to 39%
Mean visual analog scale score reduced from 7.1 to 3.0
Oswestry Disability Index decreased by 18.4 points
Early fusion status reached 91.3% at follow-up

Abstract

Background Posterior decompression for degenerative lumbar spinal stenosis (DLSS) carries approach-related morbidity. In this study, we hypothesized that multilevel lateral lumbar interbody fusion (LLIF) achieves effective indirect decompression with acceptable safety and patient-reported improvement among DLSS patients without scoliosis. Methods This was a single-institution retrospective case series (2016–2022) of adults with symptomatic spondylotic stenosis and severe disc degeneration without scoliosis (Cobb angle t tests for parametric variables and Wilcoxon signed-rank tests otherwise. Results Twenty-five patients (mean age 65.8 years; 56% men; mean body mass index 31.2 ± 5.4) underwent 57 LLIF levels with a mean follow-up of 41.3 ± 31.6 months. Central canal diameter increased by 31% (2.2 mm absolute), and foraminal height increased 17% to 39% (2.5–13.1 mm). Lumbar lordosis improved from 39.6° to 44.8°, with PI–LL mismatch improving by 5.4°. Early fusion status (BSF-3) at the last radiological assessment (mean 7.2 months) was 91.3% (21/23 evaluated). Visual analog scale score improved from 7.1 ± 2.0 to 3.0 ± 2.4 (Δ−4.1; n = 20), and Oswestry Disability Index score improved from 65.9 ± 12.9 to 47.5 ± 19.8 (Δ−18.4; n = 17). Overall complication rate was 40% with no major events; postoperative neurological complications included transient proximal lower-extremity weakness in 4% and persistent sensory symptoms in 12%. Conclusions In carefully selected DLSS patients without scoliosis, multilevel LLIF achieved meaningful indirect decompression, substantial pain and disability improvement, and high early fusion rates with no major complications. The findings support LLIF as a viable alternative to posterior approaches. Clinical Relevance Multilevel LLIF can facilitate multilevel indirect decompression with favorable radiographic and clinical outcomes while avoiding posterior soft-tissue disruption. Routine posterior instrumentation at the index surgery may support fusion and reduce returns to the OR. Level of Evidence 4.

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