Extraforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

Baek, Oon Ki; Lee, Sang-Ho

doi:10.1097/bsd.0b013e3181761528

Cited by 12 publications

(11 citation statements)

References 14 publications

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“…Commonly employed procedures include anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), or a combination of these and other minimally invasive techniques. 25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Data obtained from outcome studies do not support 1 method over another and each technique has its associated complications. 28,[42][43][44][45][46][47][48][49][50] Most of the published literature is retrospective with no standardization of either outcome measures or process measures.…”

Section: Discussionmentioning

confidence: 67%

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

Thirukumaran

Raudenbush

et al. 2016

SPINE

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Section: Discussionmentioning

confidence: 67%

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

Thirukumaran

Raudenbush

et al. 2016

SPINE

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“…Kim et al [16] stated that hypertrophic facet joint with ligamentum flavum thickening may limit the actual dimensions of the safe working zone. Finally, regarding the visceral structures in this area, Baek and Lee [10] reported that extraforaminal ligaments, transforaminal ligaments and foraminal ligamentum flavum could cause tethering of the exiting nerve root and cause of an obstacle in operating on the exiting nerve root. Due to these problems, Kim et al [16] suggested close monitoring and assessment of the pain response to inserted instruments and reviewing the imaging studies of the patients preoperatively to identify any congenital anomaly in the nerve root distorting the normal anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…The actual working zone is trapezoid shaped which correlates with the intervertebral disc (IVD) space area [9]. Nowadays, there are many minimally invasive procedures performed by accessing the IVD directly [10]. However, there is a risk of nerve root injury with this approach.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study

et al. 2016

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Study DesignAnatomical study.PurposeTo evaluate the anatomy of intervertebral disc (IVD) area in the triangular working zone of the lumbar spine based on cadaveric measurements.Overview of LiteratureThe posterolateral percutaneous approach to the lumbar spine has been widely used as a minimally invasive spinal surgery. However, to our knowledge, the actual perspective of disc boundaries and areas through posterolateral endoscopic approach are not well defined.MethodsNinety-six measurements for areas and dimensions of IVD in Kambin's triangle on bilateral sides of L1–S1 in 5 fresh human cadavers were studied.ResultsThe trapezoidal IVD area (mean±standard deviation) for true working space was 63.65±14.70 mm2 at L1–2, 70.79±21.88 mm2 at L2–3, 99.03±15.83 mm2 at L3–4, 116.22±20.93 mm2 at L4–5, and 92.18±23.63 mm2 at L5–S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83×11.02 mm at L1–2, 6.97×10.78 mm at L2–3, 9.30×10.67 mm at L3–4, 8.84×13.15 mm at L4–5, and 6.61×14.07 mm at L5–S1.ConclusionsThe trapezoidal perspective of working zone of IVD in Kambin's triangle is important and limited. This should be taken into consideration when developing the tools and instruments for posterolateral endoscopic lumbar spine surgery.

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“…The access to the intertransverse space is obstructed by the lateral part of the superior articular process of S1 and the medial portion of the sacral ala. ELIF was therefore considered not to be suitable at the L5-S1 level. 9,10 We propose a technique that makes ELIF surgery at the L5-S1 level feasible. The removal of a 2-to Unilateral foraminal stenosis and concomitant segmental instability 3-cm portion of the medial part of the sacral ala opened the working corridor to uncover the intervertebral disk from the lateral aspect of the spinal canal and to insert interbody fusion grafts without creating instability.…”

Section: Discussionmentioning

confidence: 99%

Extraforaminal Lumbar Interbody Fusion at the L5–S1 Level: Technical Considerations and Feasibility

Kurzbuch

Kaech

Baranowski³

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Extraforaminal lumbar interbody fusion (ELIF) surgery is a muscle-sparing approach that allows the treatment of various degenerative spinal diseases. It is technical challenging to perform the ELIF approach at the L5-S1 level because the sacral ala obstructs the view of the intervertebral disk space. We reported earlier on the ELIF technique in which the intervertebral disk is targeted at an angle of 45 degrees relative to the midline. In this article we describe the technical process we developed to overcome the anatomic relation between the sacral ala and the intervertebral disk space L5-S1 that hinders the ELIF approach at this level. We then report in a retrospective analysis on the short-term clinical and radiologic outcome of 100 consecutive patients with degenerative L5-S1 pathologies who underwent ELIF surgery. The L5-S1 ELIF approach could be realized in all patients. The short-term clinical outcome was evaluated 5 months after surgery: 92% of the patients were satisfied with their postoperative result; 8% had a poor result. Overall, 17% of the patients presented light radicular or low back pain not influencing their daily activity, and 82% of the patients working before surgery returned to work 3 to 7 months after surgery. The radiologic outcome was documented by computed tomography at 5 months after surgery and showed fusion in 99% of the patients. Lumbar magnetic resonance imaging performed in 5 patients at 6 months after surgery revealed the integrity of the paraspinal muscles. ELIF surgery at the L5-S1 level is technically feasible for various degenerative spinal diseases. Analysis of the clinical and radiologic data in a consecutive retrospective cohort of patients who underwent this surgical procedure showed a good short-term clinical outcome and fusion rate.

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Extraforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

Cited by 12 publications

References 14 publications

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study

Extraforaminal Lumbar Interbody Fusion at the L5–S1 Level: Technical Considerations and Feasibility

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