Mini-open approach to the spine for anterior lumbar interbody fusion

Brau, Salvador A.

doi:10.1016/s1529-9430(02)00184-5

Cited by 249 publications

(112 citation statements)

References 3 publications

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“…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%

“…This is lower than the risk of vascular complications with the midline approach, which ranges from 1.9% to 15% [3,5,7,13,39,41], and probably is attributable to use of access lateral to the abdominal vessels with the oblique psoas-sparing approach. In most instances, even because of the right lateral positioning of the patients and the left-sided approach, there is no need for any vessel preparation.…”

Section: Discussionmentioning

confidence: 87%

“…Other authors did not comment on any neurologic complications [5,39,41]. Neurologic complications are the most severe and most frequently encountered complications with the extreme lateral transpsoas approach.…”

Section: Discussionmentioning

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: 62%

Section: Discussionmentioning

confidence: 87%

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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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“…The perioperative complication rate in anterior surgery ranges from 5 to 14% in total [1,2]. Vascular injuries are however, relatively rare complications ranging from 1.9 to 18% in the literature, with the highest rates being reported in the early 1990s [3][4][5][6][7][8][9][10].…”

Section: Case Presentationmentioning

confidence: 99%

The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery

et al. 2011

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“…We can see more than 20 clips for the L4-L5 approach. For an uneventful approach to the L4/L5 disc space, we usually need no more than four or six clips for the ligature of the ascending lumbar vein and the ligature of the lumbar segmental vessels [1,2]. Some questions arise: did the surgeon or the access surgeon encounter difficulties during the anterior approach: abnormal bleeding, anatomical abnormality?…”

mentioning

confidence: 99%

Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo)

Tropiano

2009

Eur Spine J

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Mini-open approach to the spine for anterior lumbar interbody fusion

Cited by 249 publications

References 3 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

The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery

Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo)

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