Evaluation of Indirect Decompression of the Lumbar Spinal Canal Following Minimally Invasive Lateral Transpsoas Interbody Fusion: Radiographic and Outcome Analysis

Elowitz, Eric; Yanni, Daniel S.; Chwajol, Mark; Starke, R; Perin, Noel I.

doi:10.1055/s-0031-1286334

Cited by 149 publications

(130 citation statements)

References 8 publications

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“…As with conventional lateral transpsoas cages, this cage type and position is an effective method for correction of coronal deformity, lateral listhesis, restoration of foraminal height, and some correction of spondylolisthesis (1). In selected cases with good bone density, if lordosis appears adequate and foraminal height restoration is satisfactory after cage alone, then we have supplemented the cage with a 4 hole anterior plate placed through the same window, and avoided any posterior fixation (15,16) (Figure 9). …”

Section: Cage and Plate Insertionmentioning

confidence: 99%

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Gragnaniello

Seex

2016

J. Spine Surg.

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Background: Lateral interbody cages have been proven useful in spinal fusions. Spanning both lateral cortical rims while sparing the Anterior Longitudinal Ligament, the lateral interbody cages restore and maintain disc height while adding stability prior to supplemental fixation. The standard approach for their insertion is by a 90-degree lateral transpsoas method. This is relatively bloodless compared to other techniques although has its limitations, requiring neuro-monitoring and being, at times, very difficult at L4/5 due to iliac crest obstruction or an anterior plexus position. An oblique approach, with the patient in lateral decubitus, passes anterior to the iliac crest, retroperitoneal, and being anterior to psoas, eliminates the need for neuro-monitoring.Methods: Twenty-one consecutive patients underwent surgery for a total of 32 levels instrumented with the ATP technique. Mean age at the time of surgery was 62.4±7.4 years. There was a 6 months minimum clinical follow up, with imaging to assess fusion, at 6 and 12 months. Indications included symptomatic degenerative lumbar spondylosis +/− spondylolisthesis, leg and back pain. All patients were assessed with the Oswestry Disability Index (ODI), Visual Analog Scale 100 mm for back pain (VASb) and for leg pain (VASl) preoperatively, at 3, 6 and 12 months. Last follow-up was at 12 months for 9 patients and the rest had 6 months follow up.Results: Statistical analysis showed significance for the results in ODI, VASb and VASl with improvement in all components except for one patient with worsening VASl. Eight patients had complications related to surgery which were still present at last follow-up including moderate weakness of hip flexion and EHL weakness. Lateral cutaneous nerve (LCN) palsy on the side of the approach was also seen as well as sympathectomy effect related to the mobilization of the sympathetic trunk. One patient, who also suffered from multiple sclerosis, experienced psoas abscess 3 months post op that required drainage. Conclusions:The left sided anterior to psoas approach offers the most natural corridor to the disc space.The novel instruments and method described here allows insertion of large lateral cages between L2 to L5, without the problems associated with the transpsoas approach, particularly at L4/5.

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Section: Cage and Plate Insertionmentioning

confidence: 99%

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Gragnaniello

Seex

2016

J. Spine Surg.

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“…Marchi et al [35] 2012 XLIF PCS Spondylolisthesis 52 -Sharma et al [36] 2011 XLIF RCS Spondylosis ± listhesis, scoliosis 43 -Pimenta et al [25] 2011 XLIF PCS DDD 36 -Ahmadian et al [37] 2013 XLIF RCS L4/L5 spondylolisthesis 31 -Caputo et al [38] 2012 XLIF PCS Scoliosis 30 -Malham et al [39] 2012 XLIF PCS DDD, spondylolisthesis, scoliosis 30 - 4 Pimenta et al [40] 2013 XLIF RCT L4/L5 DDD 30 -Elowitz et al [41] 2011 XLIF PCS LSS 25 -Oliveira et al [42] [27] ----28% 24% --Smith et al [28] 112 ± 31 173 ± 31 90 ± 74 311 ± 370 3% 6% 1.7 ± 1.3 3.6 ± 0.9 Rodgers et al [12] --1.4 g Hb 2.7 g Hb --1.3 5.3 Huang et al [29] 176 ± 8 202 ± 15 572 ± 93 970 ± 209 --11.6 ± 1.3 12.5 ± 1.3 Case series Rodgers et al [13] --1.38 g Hb -1% -1.2 -Ruetten et al [30] …”

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confidence: 99%

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

Skovrlj¹

2015

WJO

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AIM:To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS). METHODS:A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant. RESULTS:

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“…4,8,22,24 However, there has been some reservation among surgeons regarding the safety of MIS-LIF at the L4-5 disc space because of the risk of lumbar plexus injury, particularly the femoral nerve. Reported motor nerve complication rates vary widely, ranging from 0.7% to 33.6%, 9,21,25,28,34 and there is concern that the risk may be greater with the presence of spondylolisthesis. The literature is limited as regards the minimally invasive lateral approach for patients with spondylolisthesis.…”

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Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

Ahmadian

Verma

Oskouian

et al. 2013

SPI

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Object In this study the authors report on the clinical outcomes, safety, and efficacy of lateral retroperitoneal transpsoas minimally invasive surgery–lumbar interbody fusion (MIS-LIF) at the L4–5 disc space in patients with spondylolisthesis. This approach has become an increasingly popular means of fusion. Its most frequent complication is lumbar plexus injury. Reported complication rates at the L4–5 disc space vary widely in the literature, bringing into question the safety of MIS-LIF for the L4–5 region, especially in patients with spondylolisthesis. Methods The authors retrospectively reviewed prospectively acquired multicenter databases of patients with Grade I and II L4–5 spondylolisthesis who had undergone elective MIS-LIF between 2008 and 2011. Clinical follow-up had been scheduled for 1, 3, 6, 12, and 24 months postoperatively. Outcome measures included estimated blood loss, operative time, length of hospital stay, integrity of construct, complications, fusion rates, visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36). Results Eighty-four patients with L4–5 MIS-LIF were identified, 31 of whom met the study inclusion criteria: 26 adults with Grade I and 5 adults with Grade II L4–5 spondylolisthesis who had undergone elective MIS-LIF and subsequent posterior percutaneous pedicle screw fixation without surgical manipulation of the posterior elements (laminectomy, foraminotomy, facetectomy). The study cohort consisted of 9 males (29%) and 22 females (71%) with an average age of 61.5 years. The mean total blood loss was 94 ml (range 20–250 ml). The mean hospital stay and follow-up were 3.5 days and 18.2 months, respectively. The average score on the ODI improved from 50.4 preoperatively to 30.9 at the last follow-up (p < 0.0001). The SF-36 score improved from 38.1 preoperatively to 59.5 at the last follow-up (p < 0.0001). The VAS score improved from 69.9 preoperatively to 38.7 at the last follow-up (p < 0.0001). No motor weakness or permanent deficits were documented in any patient. Correction of deformity did not have any neurological complications. All patients had improvement in anterolisthesis. Residual postoperative listhesis across cases was noted in 4 patients (12.9%). Transient anterior thigh numbness (Sensory Dermal Zone III) was noted in 22.5% of patients. Conclusions With its established surgical corridors through the retroperitoneum and psoas muscle, the MIS-LIF combined with posterior percutaneous pedicle screw fixation/reduction is a safe, reproducible, and effective technique for patients with symptomatic degenerative spondylolisthesis at the L4–5 vertebral segment.

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Evaluation of Indirect Decompression of the Lumbar Spinal Canal Following Minimally Invasive Lateral Transpsoas Interbody Fusion: Radiographic and Outcome Analysis

Cited by 149 publications

References 8 publications

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

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