Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody Fusion

Rodgers, W. B.; Gerber, Edward J.; Patterson, Jamie

doi:10.1097/brs.0b013e3181e1040a

Cited by 450 publications

(310 citation statements)

References 33 publications

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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%

“…To reduce risk of vascular injury, lateral approaches have been established [28,29]. The ''extreme'' or ''direct lateral'' transpsoas approaches have increased in popularity, partly because of the natural distance to the abdominal vessels [19,30,38,40]. However, numerous studies have shown neurologic injury resulting from this transpsoas approach, which is in close anatomic proximity to the lumbar nerve plexus [2,16,18,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Although the disc space can be reached from a strictly lateral direction, this approach risks neurologic injuries while dissecting the psoas muscle [4]. This is why neuromonitoring is considered mandatory [38,40]. However, even with neuromonitoring there is a high risk of approach-related neurologic and muscular complications.…”

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: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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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“…Similarly, an anterior approach to MIS cervical decompression is utilized to prevent damage to the posterior cervical paraspinal musculature [5]. These techniques may result in less postoperative instability, less intraoperative blood loss, a shorter hospital stay, and a lower infection rate than traditional open procedures [5,10,14,22]. Potential longterm benefits include less postoperative instability, which could lead to improved patient function.…”

Section: Introductionmentioning

confidence: 99%

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Sclafani

Kim

2014

Clinical Orthopaedics &Amp; Related Research

208

167

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Background There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion. The association between complication rate and the learning curve remains unclear. Questions/purposes We performed a systematic review for articles that evaluated the learning curves of MIS procedures for the spine, defined as the change in frequency of complications and length of surgical time as case number increased, for five types of MIS for the spine. Methods We conducted a systematic review in the PubMed database using the terms ''minimally invasive spine surgery AND complications AND learning curve'' followed by a manual citation review of included manuscripts. Clinical outcome and learning curve metrics were categorized for analysis by surgical procedure (MIS lumbar decompression procedures, MIS transforaminal lumbar interbody fusion, percutaneous pedicle screw insertion, laparoscopic anterior lumbar interbody fusion, and MIS cervical procedures). As the most consistent parameters used to evaluate the learning curve were procedure time and complication rate as a function of chronologic case number, our analysis focused on these. The search strategy identified 15 original studies that included 966 minimally invasive procedures. Learning curve parameters were correlated to chronologic procedure number in 14 of these studies. Results The most common learning curve complication for decompressive procedures was durotomy. For fusion procedures, the most common complications were implant malposition, neural injury, and nonunion. The overall postoperative complication rate was 11% (109 of 966 cases). The learning curve was overcome for operative time and complications as a function of case numbers in 20 to 30 consecutive cases for most techniques discussed within this review. Conclusions The quantitative assessment of the procedural learning curve for MIS techniques for the spine remains challenging because the MIS techniques have different learning curves and because they have not been assessed in a consistent manner across studies. Complication rates may be underestimated by the studies we identified because surgeons tend to select patients carefully during the early learning curve period. The field of MIS would benefit from a standardization of study design and collected parameters in future learning curve investigations.

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Anatomy of psoas muscle innervation: Cadaveric study

et al. 2017

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Hip flexion weakness is relatively common after lateral transpsoas surgery. Persistent weakness may result from injury to the innervation of the psoas major muscles (PMMs); however, anatomical texts have conflicting descriptions of this innervation, and the branching pattern of the nerves within the psoas major, particularly relative to vertebral anatomy, has not been described. The authors dissected human cadavers to describe the branching pattern of nerves supplying the PMMs. Sixteen embalmed cadavers were dissected, and the fine branching pattern of the innervation to the PMM was studied in 24 specimens. The number of branches and width and length of each branch of nerves to the PMMs were quantified. Nerve branches innervating the PMMs arose from spinal nerve levels L1-L4, with an average of 6.3 ± 1.1 branches per muscle. The L1 nerve branch was the least consistently present, whereas L2 and L3 branches were the most robust, the most numerous, and always present. The nerve branches to the psoas major commonly crossed the intervertebral (IV) disc obliquely prior to ramification within the muscle; 76%, 80%, and 40% of specimens had a branch to the PMM cross the midportion of the L2-3, L3-4, and L4-5 IV discs, respectively. The PMMs are segmentally innervated from the L2-L4 ventral rami branches, where these branches course obliquely across the L2-3, L3-4, and L4-5 IV discs. Knowledge of the mapping of nerve branches to the PMMs may reduce injury and the incidence of persistent weak hip flexion during lateral transpsoas surgery. Clin. Anat. 30:479-486, 2017. © 2017 Wiley Periodicals, Inc.

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Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody Fusion

Cited by 450 publications

References 33 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

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Anatomy of psoas muscle innervation: Cadaveric study

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