Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years' follow-up

Pimenta, Luiz; Oliveira, Leonardo; Schaffa, Thomas; Coutinho, Etevaldo; Marchi, Luís

doi:10.3171/2010.9.spine09865

Cited by 97 publications

(66 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Neurologic deficit following lateral lumbar interbody fusion

et al. 2011

View full text Add to dashboard Cite

show abstract

“…The complications were broken down into sensory (dysethesia, paraesthesia, or hypoesthesia), motor (distal weakness), and muscular (iliopsoas weakness or hematoma) deficits. The results are summarized in Tables 4 and 5. 1,2,4,7,9,10, [16][17][18][19]21,23,24,26,29,30,32 Mayer previously described an oblique MIS access to the L2-5 discs through a retroperitoneal approach and a transperitoneal approach to access the L5-S1 disc. 20 Saraph et al compared a traditional open anterior approach with Mayer's MIS approach and found that although fusion and complication rates were similar in their study, the MIS group had shorter operating time, less blood loss, and decreased postoperative pain.…”

Section: 1019mentioning

confidence: 99%

“…15,27 The lateral transpsoas MIS approach, first described by Pimenta et al, does not require an access surgeon and allows for access to the spine without the need to mobilize the great vessels or sympathetic nerves. 19,23,33 Access to the spine is gained through a far-lateral incision that enters the retroperitoneal space and requires dissection through the psoas muscle. The most devastating injury is femoral nerve palsy with complete loss of quadriceps strength.…”

Section: 1019mentioning

confidence: 99%

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

Davis

Hynes²,

Fung

et al. 2014

SPI

165

145

View full text Add to dashboard Cite

Object Access to the intervertebral discs from L2–S1 in one surgical position can be challenging. The transpsoas minimally invasive surgical (MIS) approach is preferred by many surgeons, but this approach poses potential risk to neural structures of the lumbar plexus as they course through the psoas. The lumbar plexus and iliac crest often restrict the L4–5 disc access, and the L5–S1 level has not been a viable option from a direct lateral approach. The purpose of the present study was to investigate an MIS oblique corridor to the L2–S1 intervertebral disc space in cadaveric specimens while keeping the specimens in a lateral decubitus position with minimal disruption of the psoas and lumbar plexus. Methods Twenty fresh-frozen full-torso cadaveric specimens were dissected, and an oblique anatomical corridor to access the L2–S1 discs was examined. Measurements were taken in a static state and with mild retraction of the psoas. The access corridor was defined at L2–5 as the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 corridor of access was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel and vertically to the first vascular structure that crosses midline. Results The mean access corridor diameters in the static state and with mild psoas retraction, respectively, were as follows: at L2–3, 18.60 mm and 25.50 mm; at L3–4, 19.25 mm and 27.05 mm; and at L4–5, 15.00 mm and 24.45 mm. The L5–S1 corridor mean values were 14.75 mm transversely, from midline to the left common iliac vessel and 23.85 mm from the inferior endplate of L-5 cephalad to the first midline vessel. Conclusions The oblique corridor allows access to the L2–S1 discs while keeping the patient in a lateral decubitus position without a break in the table. Minimal psoas retraction without significant tendon disruption allowed for a generous corridor to the disc space. The L5–S1 disc space can be accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2–S1 discs.

show abstract

“…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%

“…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

View full text Add to dashboard Cite

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.

show abstract

Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years' follow-up

Cited by 97 publications

References 29 publications

Neurologic deficit following lateral lumbar interbody fusion

Neurologic deficit following lateral lumbar interbody fusion

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

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

Contact Info

Product

Resources

About