Minimally Invasive Surgery: Lateral Approach Interbody Fusion

Youssef, Jim A.; McAfee, Paul C.; Patty, Catherine A.; Raley, Erin; DeBauche, Spencer; Shucosky, Erin M.; Chotikul, Liana

doi:10.1097/brs.0b013e3182023438

Cited by 277 publications

(167 citation statements)

References 64 publications

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“…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%

“…Furthermore, patient positioning in the proper orientation (hips and knees flexed) could help avoid femoral nerve stretch and allows for more gentle dissection upon retractor employment. All of these factors could reduce the chances of neuropraxia [16]. Although Park et al [6] showed that the lumbar plexus with hip flexion travels more anterior (non-significant) the advantages of a relaxed and therefore easier-to-dissect muscle seem to out weigh the change in position of the nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Other critical factors are the relationship of the pelvis to L4-5 level, the coronal angulation of the approached disc space and the side of the concavity of the curve. Additionally, table flexion might give the surgeon more room for the approach; however, it has been previously suggested that it might cause over stretch of the femoral nerve [16]. Special attention towards a safe approach should be considered in scoliosis cases.…”

Section: Discussionmentioning

confidence: 99%

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Neurologic deficit following lateral lumbar interbody fusion

et al. 2011

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neurologic deficit following lateral lumbar interbody fusion

et al. 2011

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“…In a series of 84 patients with a mean 15.7 month follow-up, 68 patients demonstrated solid arthrodesis on a computed tomography scan. Peri-and postoperative complications were 2.4% and 6.1%, respectively [9]. Another series of 600 patients and 741 levels reported no wound infections, vascular injuries, or intraoperative visceral injuries, but four cases (0.7%) of transient postoperative neurologic deficit occurred [3].…”

Section: Outcomes and Complicationsmentioning

confidence: 95%

Lateral Lumbar Interbody Fusion

Sharma

Kepler

Girardi

et al. 2011

Journal of Spinal Disorders &Amp; Techniques

208

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The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques.

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“…The concept of minimally invasive, extreme lateral interbody fusion (XLIF) technique was first reported in early 2000s by Pimenta [1] and has gained widespread acceptance among spine surgeons [2]. It is based on lateral retroperitoneal transpsoas approach and electrophysiological navigation inside the psoas major muscle to avoid damaging the lumbar plexus.…”

Section: Introductionmentioning

confidence: 99%

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients

Aghayev

Vrionis

2013

Eur Spine J

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Purpose The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route. Methods The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus. Results Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit. Conclusions Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

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Minimally Invasive Surgery: Lateral Approach Interbody Fusion

Cited by 277 publications

References 64 publications

Neurologic deficit following lateral lumbar interbody fusion

Neurologic deficit following lateral lumbar interbody fusion

Lateral Lumbar Interbody Fusion

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients

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