A case report of a rare complication of bowel perforation in extreme lateral interbody fusion

Balsano, Massimo; Carlucci, Stefano; Ose, Marija; Boriani, Luca

doi:10.1007/s00586-015-3881-6

Cited by 54 publications

(47 citation statements)

References 17 publications

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“…70 While we do currently gather these data clinically, some patients within the PSO group did not have these data available for review, so they are not reported here. Likewise, there is a lack of data regarding minor adverse outcomes, although we can report that no patients in either group experienced a major complication of bowel injury, 8 hardware failure within 30 days, or death. There have been 2 recent studies suggesting that neurological Corr L1-2 L2-3 L3-4 L4-5 LL PI-LL LL PI-LL 1 63, F T10-pelvis 30 20 30 10 90 24 37 55 4 31 2 73, M L2-5 20 30 10 60 32 16 41 5 9 3 52, M T10-pelvis 20 30 50 33 24 61 −4 28 4 62, M T9-pelvis 30 20 30 80 14 31 48 −9 34 5 68, F T3-pelvis 20 30 30 80 30 29 61 6 21 6 54, F T4-pelvis 30 30 20 Clinical summary of 13 cases involving patients with ASD treated using hyperlordotic lateral interbody grafts.…”

Section: Discussionmentioning

confidence: 95%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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OBJECTIVEPedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20°–30°) interbody cages, with stabilization through standard posterior instrumentation in all cases.METHODSThe authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors’ institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.RESULTSThe PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35° in the PSO group, 31° in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33° in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1° in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.CONCLUSIONSThis is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.

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Section: Discussionmentioning

confidence: 95%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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“…To avoid violation of the peritoneum with subsequent visceral injuries, complete development of the retroperitoneal space during the LLIF approach is crucial [60]. Two cases of bowel perforation secondary to LLIF have been described in the literature [60,61].…”

Section: Visceral Injurymentioning

confidence: 99%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

119

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Purpose of Review Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications. Recent Findings Since the first description of the technique in 2006, the indications for LLIF have expanded and the rate of LLIF procedures performed in the USA has increased. LLIF has several theoretical advantages compared to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern. Summary In well-indicated patients, LLIF can be a safe procedure used for a variety of indications.

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“…Among these complications, segmental arterial injury and bowel perforation are fatal, and only a few reports regarding how to avoid these complications are available (6)(7)(8)(9). These complications are troublesome because it is very difficult to find these complications during surgery owing to the narrow surgical space and the limited visual field.…”

Section: Introductionmentioning

confidence: 99%

“…However, some major complications are associated with the lateral approach, such as lumbar nerve plexus injury, segmental arterial injury and bowel perforation (4)(5)(6). Among these complications, segmental arterial injury and bowel perforation are fatal, and only a few reports regarding how to avoid these complications are available (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of microendoscopy-assisted extreme lateral interbody fusion

Segawa¹,

Inanami²,

Koga³

2017

J. Spine Surg.

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Background: Extreme lateral interbody fusion (XLIF) has rapidly become a popular operative procedure for lumbar canal stenosis and scoliosis. This approach provides direct access to the lateral aspect of the disc with minimal disruption of spinal structures, including ligaments and muscles. However, it involves risk of injuries to the lumbar nerve plexus, segmental artery and intestinal tract because of the limited surgical field.This study aimed to clarify the benefit of using a microendoscope to prevent these injuries.Methods: A total of 96 consecutive patients treated by a single surgeon were retrospectively analyzed. The basic approach via the psoas muscle was performed in accordance with the conventional XLIF procedure.Operative manipulations, such as insertion of the shim, discectomy, endplate preparation and intervertebral spacer placement, were performed with the assistance of a microendoscope. Preoperative and postoperative neurological status were evaluated using the Japanese Orthopedic Association (JOA) scores and the Oswestry Disability Index (ODI).Results: Eighty-four patients underwent surgery for a single vertebral level, nine patients underwent surgery for 2 levels and three patients underwent surgery for 3 levels (average, 1.2 levels). The average age of patients was 61 years (range, 22-83 years); the mean follow-up period was 18 months (range, 3-36 months). Average preoperative and postoperative JOA scores were 11.9 and 15.6, with a mean recovery rate of 33%. Average preoperative and postoperative ODI scores were 38.6 and 19.1. There were 3 (3.1%) complications: 2 end-plate fractures and 1 deep surgical site infection. There were no bowel perforations or vascular injuries.Conclusions: Microendoscopy assistance is one solution for severe visceral and vascular injuries related to XLIF.

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A case report of a rare complication of bowel perforation in extreme lateral interbody fusion

Cited by 54 publications

References 17 publications

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Clinical evaluation of microendoscopy-assisted extreme lateral interbody fusion

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