Complications and neurological deficits following minimally invasive anterior column release for adult spinal deformity: a retrospective study

Murray, Gisela; Beckman, Joshua; Bach, Konrad; Smith, Donald A.; Dakwar, Elias; Uribe, Juan S.

doi:10.1007/s00586-015-3894-1

Cited by 63 publications

(31 citation statements)

References 32 publications

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“…complications with LLIF-ACR are less than with PSO, 52,60 and this is supported by our data from the present study, although further studies will be needed to substantiate this assertion.…”

Section: Discussionsupporting

confidence: 80%

“…1,2,7,15,23,24,27,37,48,56,57,62 More advanced techniques involving the use of hyperlordotic cages with anterior longitudinal ligament (ALL) release and anterior column realignment (ACR) via a lateral technique allow for a significant gain in LL with the added benefit of coronal balance restoration and indirect neuroforaminal decompression at multiple levels in a single procedure. 11,14,41,46,47,52,71,75 Here we compare our series of patients undergoing PSO or multiple-level LLIF with ACR for the correction of ASD and examine intraoperative estimated blood loss (EBL), operative time, length of stay (LOS), and change in spinopelvic parameters as well as perioperative and postoperative complications.…”

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confidence: 99%

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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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“…complications with LLIF-ACR are less than with PSO, 52,60 and this is supported by our data from the present study, although further studies will be needed to substantiate this assertion.…”

Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

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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“…We observed five superficial (0.62%) and six deep (0.74%) hematomas. Comparable figures have been reported for other types of less-invasive lateral approaches from 0.17% to 6% [23,34,40]. Our transmuscular approach may have contributed to a slight increase of postoperative retroperitoneal hematomas.…”

Section: Discussionsupporting

confidence: 74%

“…Our transmuscular approach may have contributed to a slight increase of postoperative retroperitoneal hematomas. Our overall infection risk of 0.62% is comparable to those reported for the midline or extreme lateral access routes of 0% to 6% [5,12,15,24,32,34,[39][40][41]. With respect to previous studies on the oblique psoas-sparing approach, in the largest series of 179 patients, Silvestre et al [44] did not report on the general risk of infection and hematoma.…”

Section: Discussionsupporting

confidence: 62%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

137

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Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoassparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported. Questions/purposesWe asked: what proportion of patients experienced (1) perioperative complications (overall complications), (2) vascular complications, and (3) neurologic complications after less-invasive anterior lumbar interbody fusion through the oblique lumbar interbody approach at one high-volume center? Methods We performed a chart review of intra-and perioperative complications of all patients who had undergone minimally invasive anterior lumbar interbody fusion through a lateral psoas-sparing approach from L1 to L5 during a 12-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). During the study period, the oblique, psoas-sparing approach was the preferred approach of the participating surgeons in this study, and it was performed in 812 patients, all of whom are studied here, and all of whom have complete data for assessment of the short-term (inpatient-only) complications that we studied. In general, we performed this approach whenever possible, although it generally was avoided when a patient previously had undergone an open retro-or transperitoneal abdominal procedure, or previous implantation of hernia mesh in the abdomen. During the study period, posterior fusion techniques were used in an additional 573 patients instead of the oblique lumbar interbody fusion when we needed to decompress the spinal canal beyond what is possible through the anterior approach. In case of spinal stenosis calling for fusion in combination with a high disc space, severe endplate irregularity, or severe biomechanical instability, we combined posterior decompression with oblique lumbar interbody fusion in 367 patients. Complications were evaluated by an independent observer who was not involved in the decisionmaking process, the operative procedure, nor the Each author certifies that he or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 ed...

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“…As this approach has the potential risk for intraperitoneal or retroperitoneal structures (including viscera and vessels), surgical exposure requires extensive mobilization of the great vessels and the peritoneal content. Traditional ALIF method using a wide-open anterior approach, have largely been abandoned because of significant compli- 73,76,[82][83][84][85][86] , with some complications being catastrophic [87][88][89] . As the lateral approach requires mobilization of the peritoneum for exposure to the retroperitoneal space and subsequent lateral access, misunderstanding about the peritoneum and inadequate exposure to the retroperitoneal space increases the risk of injury to the peritoneum and its content.…”

mentioning

confidence: 99%

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra-and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

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Complications and neurological deficits following minimally invasive anterior column release for adult spinal deformity: a retrospective study

Cited by 63 publications

References 32 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

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

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