A modified Delphi method has been used to ascertain expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery in an effort to inform clinical decision-making in the application of lateral lumbar interbody fusion (LLIF). The results of the study were presented by Yong Hai (Beijing Chaoyang Hospital, Beijing, China) at the Global Spine Congress 2022 (1–4 June; Las Vegas, USA) where it won the Global Spine Journal Best Paper award.
A total of 65 spine surgeons from across China agreed to participate in the modified Delphi method study. Four rounds were performed: one face-to-face meeting and three subsequent survey rounds.
The study found that the best indications for LLIF are adjacent segment disease (ASD), adult degenerative scoliosis (ADS), and lumbar degenerative spondylolisthesis grades one and two. In addition, the major contraindications for LLIF are grade three or above spondylolisthesis and retroperitoneal surgery / disease.
Other areas of consensus that were achieved include: That preoperative MRI and dual energy X-ray absorptiometry are mandatory; convex side access is better in ADS; nerve injury is caused by exposure and traction injuries and is best relieved by neuropathic drugs.
The consensus was defined as being achieved with a ≥70% agreement for each question. The recommendation of Grade A was defined as ≥90% of the agreement for each question. The recommendation of Grade B was defined as 80-89.9% of the agreement for each question. The recommendation of Grade C was defined as 70-79.9% of the agreement for each question.
A total of 63 participants responded to the first questionnaire and 176 options achieved consensus. Fifty-nine participants responded to the second questionnaire with 37 options achieving consensus and 62 participants responded to the final questionnaire where 25 options achieved consensus. In total, 71 questions including 238 options achieved consensus after the Delphi rounds. Grade A was achieved in 34.9% of options, Grade B in 23.7% of options, and Grade C in 41.4% of options.
Speaking to Spinal News International, Hai said: “LLIF has been one of the popular procedures in the field of spinal surgery worldwide in recent years, due to its less invasive nature, greater anterior column support and restoration of lumbar alignment. It is also controversial because of the indications and complications of this procedure.
“We hope this expert consensus can provide valuable information for our peers regarding the application of this technology, under the status of lacking adequate prospective randomised controlled trials.”