Early Complications of Extreme Lateral Interbody Fusion in the Obese

Background The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion. Question/purposes We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach. Methods Between 2008 and 2012, 158 patients were surgically treated to alleviate symptoms associated with degenerative lumbar stenosis, of whom 60 (38%) were treated with lateral lumbar interbody fusion. Of these 60 patients, 36 (60%) received CT scans preoperatively and at 1-year postoperatively and were available for radiographic analysis. Of the 60 treated patients, 16 (27%) were lost to followup before 12 months, leaving the records of 44 patients available for review of patient-reported improvements in pain and return to function. Radiographic increases in disc height, foraminal area, and canal area were measured by one observer on CT scans postoperatively and at 1 year and compared to preoperative values. Patient-reported scores, including VAS pain score and Oswestry Disability Index (ODI), were collected preoperatively and at 3 and 12 months postoperatively.

Section: Discussionmentioning

confidence: 99%

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Castellvi

Nienke

Marulanda

et al. 2014

“…In recent years, a minimally disruptive lateral transpsoas retroperitoneal technique to accomplish interbody fusion has been developed as an alternative approach to avoid the morbidity of traditional open surgery [2,29]; proof-ofconcept has been established even in elderly and obese patients [32,33]. This approach, also called lateral lumbar interbody fusion, is mostly utilized with posterior supplementation but can be used as a stand-alone anterior construction since it preserves the anterior longitudinal ligament [24], avoiding disruption of posterior stabilizing structures, permitting insertion of a large interbody graft, and restoring foraminal height with a larger surface area for arthrodesis [23,24,27].…”

Section: Introductionmentioning

confidence: 99%

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

Castro

Oliveira

Amaral

et al. 2014

Background Lumbar degenerative scoliosis is a common condition in the elderly. Open traditional surgical approaches are associated with high-morbidity complication rates. Less invasive options may carry fewer risks in this patient population. A minimally disruptive lateral transpsoas retroperitoneal technique to accomplish interbody fusion was developed to avoid the morbidity of traditional open surgery, but this approach as an anterior stand-alone construction has not been reported yet for the treatment of adult degenerative scoliosis.Questions/purposes We determined (1) the clinical outcomes (VAS scores for back and leg, Oswestry Disability Index), (2) the radiographic outcomes (Cobb angle, lumbar lordosis, sacral slope, high-grade subsidence, osseous fusion), and (3) the reoperation and complication rates in an older population undergoing this surgical approach. Methods Between 2004 and 2008, 62 patients were treated surgically for adult degenerative scoliosis, of whom 46 (74%) were treated with stand-alone lateral lumbar interbody fusion; 11 of these (24%) were lost to followup before 24 months, leaving the records of 35 patients (nine men, 26 women; mean ± SD age, 68 ± 10 years) available for this retrospective review. General indications for this approach included neurogenic claudication and radicular symptoms with history of chronic low-back pain. A total of 107 levels were treated (mean, three; range, one to seven). Clinical and radiographic outcomes were assessed at a followup of 24 months.

“…These symptoms resolved completely within four to six weeks in all cases.'' Some authors considered the side effect profile of transient thigh discomfort to be a complication [7, 12-15, 20, 32-34, 36], while others described it as an accepted, approach-related symptom [16,26,37]. Other authors attempted to categorically identify their complications, listing ''major adverse events'' versus ''approach-related complaints'' [15] or as ''major and minor'' [12].…”

Section: Discussionmentioning

confidence: 99%

“…Studies from our systematic review that have characterized the complications of lateral transpsoas approaches (Table 2) included adverse medical outcomes (ileus, pneumonia, renal, pulmonary embolus, cardiac [26,27], anemia, volvulus [27], rhabdomyolysis [7], pleural effusion, sepsis [12]) and surgery-specific complications (vertebral fracture [14,26,27,32], end plate fracture [27], iatrogenic herniated nucleus pulposus [27], graft subsidence [7], sensory disturbance [14-16, 20, 26, 32, 33], Yes XLIF = extreme lumbar interbody fusion; ALIF = anterior lumbar interbody fusion; TDR = total disc replacement; fx = fracture; DDD = degenerative disc disease; HNP = herniated nucleus pulposus; EP = endplate; VB = vertebral body; OP = osteophyte; MI = myocardial infarction; DVT = deep venous thrombosis; PE = pulmonary embolism; A fib = atrial fibrillation; CSF = cerebrospinal fluid. motor deficits [12, 14-16, 20, 26, 27, 32, 33], incisional hernias [4,26], hardware failures [12,27], loss of fixation [15], malpositioned cage, retroperitoneal hemorrhage [32], hematoma [27],wound infection [12,20], durotomy, pneumothorax, and peritoneum perforation [33]). Second, none of the literature reviewed was of high quality.…”

Section: Discussionmentioning

confidence: 99%

“…Anteriorapproach complications include damage to the abdominal organs (\ 1%), vascular injury (1.3%-15.6%), disruption of the sympathetic plexus (1.7%-13.3%), and postoperative ileus (0.6%-5.6%) [6,[29][30][31]. Posterior approaches avoid the aforementioned risks but can lead to soft tissue devitalization, nerve root injuries (9%-16%), postoperative radiculitis (6.7%-16.4%), and incidental durotomies (5.4%-10%) [5,9,26,31]. Newer surgical techniques were developed in hopes of minimizing surgical risks, decreasing in-hospital stay, and potentially improving patient satisfaction [17].…”

Section: Introductionmentioning

confidence: 99%

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

Sofianos

Briseño

Abrams

et al. 2012

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.