Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Tormenti, Matthew J.; Maserati, Matthew B.; Bonfield, Christopher M.; Okonkwo, David O.; Kanter, Adam S.

doi:10.3171/2010.1.focus09263

Cited by 251 publications

(209 citation statements)

References 25 publications

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“…In a review summarizing 18 studies with a total of 2310 patients, 304 patients had complications related to lumbar plexus injury representing a 13% risk [2] despite intraoperative neuromonitoring. Although many of these complications were reported as transient, persisting neurologic symptoms might occur in different intensity in as much as 18% [15,25,33,46]. Because the access corridor is transmuscular for this technique, intramuscular preparation is likely the main underlying reason for the abovedescribed nerve root injury.…”

Section: Discussionmentioning

confidence: 99%

“…However, even with neuromonitoring there is a high risk of approach-related neurologic and muscular complications. The risk of postoperative hip flexor and quadriceps weakness, which are considered to be approach-related muscular trauma, range between 20% and 36%, whereas sensory deficits and anterior thigh pain range between 25% and 75% and 23% and 60%, respectively [15,20,25,33,43,46].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Surgeons have theorized that this may be related to direct cutaneous nerve neuropraxia or an indirect mechanism via a psoas muscle inflammatory response due to mechanical dissection. The incidence of this varies considerably in the literature from 1 to 75% [2,[10][11][12]. Several studies have reported on post-operative neurologic deficits following LLIF.…”

Section: Discussionmentioning

confidence: 99%

“…However, the determination of absolute prevalence of deficits and their natural history as well as contributing factors remains incomplete and controversial in the literature. Overall, the number of postoperative neurologic events ranges in literature between 0.6 and 33.6% after LLIF [10,11,[13][14][15][16]. In a study by Tohmeh et al [12] 28% of patients experienced a new iliopsoas weakness and 18% claimed of sensory loss at the upper medial thigh although intra-operative real-time monitoring was used to prevent neurologic deficits after LLIF.…”

Section: Discussionmentioning

confidence: 99%

Neurologic deficit following lateral lumbar interbody fusion

et al. 2011

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Purpose Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that has gained growing interest in recent years. We performed a retrospective review of the medical records and operative reports of patients undergoing LLIF between March 2006 and December 2009. We seek to identify the incidence and nature of neurological deficits following LLIF. Methods New occurring sensory and motor deficits were recorded at 6 and 12 weeks as well as 6-and 12 months of follow-up. Motor deficits were grouped according to the muscle weakness and severity and sensory deficits to the dermatomal zone. New events were correlated to the patient demographics, pre-operative diagnosis, operative levels, and duration of surgery. At each post-operative time-point patients were queried regarding the presence of leg pain. Results A total of 235 patients (139 F; 96 M) with a total of 444 levels fused were included. Average age was 61.5 and mean BMI 28.3. At 12 months' follow-up, the prevalence of sensory deficits was 1.6%, psoas mechanical deficit was 1.6% and lumbar plexus related deficits 2.9%. Although there was no significant correlation between the surgical level L4-5 and an increased psoas mechanical flexion or lumbar plexus related motor deficit, a trend was observed. Independent risk factors for both psoas mechanical hip flexion deficit and lumbar plexus related motor deficit was duration of surgery.

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“…The average reported followup ranged from 2 days to 24 months [7, 12-16, 20, 26, 27, 32-34, 36]. VAS pain score, reported in eight of 13 studies, improved on average from 8.3 to 3.6, and ODI, reported in five of 13 studies, improved on average from 48.1 to 27.3 [7,13,14,16,20,27,32,34,36].…”

Section: Discussionmentioning

confidence: 99%

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Sofianos

Briseño

Abrams

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary. Questions/purposes We identified the incidence of complications associated with the lateral transpsoas approach to the lumbar spine. Patients and Methods We retrospectively reviewed 45 patients who underwent a lateral transpsoas approach to the spine for various diagnoses between January 1, 2006, and October 31, 2010. The patients' average age was 63.3 years. Sixteen (35.6%) patients had prior lumbar spinal surgery.Twenty-one patients (46.7%) underwent supplemental posterior instrumentation. Minimum followup was 0 months (mean, 11 months; range, 0-34 months). Results Eighteen of the 45 patients (40%) had complications: 10 (22.2%) developed postoperative iliopsoas weakness, three had quadriceps weakness, and one experienced foot drop. Eight patients (17.8%) developed anterior thigh hypoesthesia, which did not fully resolve in seven of the eight patients at an average of 9 months' followup. Three patients had postoperative radiculopathies, one a durotomy, and one died postoperatively from a pulmonary embolism. Conclusions We found a 40% incidence of complications and a nontrivial frequency and severity of postoperative weakness, numbness, and radicular pain in patients who underwent a lateral transpsoas approach to the spine. Given the expanding use of the approach, a thorough understanding of the risks associated with it is essential for patient education, medical decision making, and identifying methods of reducing such complications.

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Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Cited by 251 publications

References 25 publications

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

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

Neurologic deficit following lateral lumbar interbody fusion

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

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