Neurologic Injury in Complex Adult Spinal Deformity Surgery

Abstract

Study Design. A retrospective review of prospectively collected data. Objective. The aim of this study was to determine the safety of MOLIF versus PSO. Summary of Background Data. Complex adult spinal deformity (CASD) represents a challenging cohort of patients. The Scoli-RISK-1 study has shown a 22.18% perioperative risk of neurological injury. Restoration of sagittal parameters is associated with good outcome in ASD. Pedicle subtraction osteotomies (PSO) is an important technique for sagittal balance in ASD but is associated with significant morbidity. The multilevel oblique lumbar interbody fusion (MOLIF) is an extensile approach from L1 to S1. Methods. Single surgeon series from 2007 to 2015. Prospectively collected data. Scoli-RISK-1 criteria were refined to only include stiff or fused spines otherwise requiring a PSO. Roentograms were examined preoperatively and 2 year postoperatively. Primary outcome measure was the motor decline in American Spinal Injury Association (ASIA) at hospital discharge, 6 weeks, 6 months, and 2 years. Demographics, blood loss, operative time, spinopelvic parameters, and spinal cord monitoring (SCM) events. Results. Sixty-eight consecutive patients were included in this study, with 34 patients in each Group. Group 1 (MOLIF) had a mean age 62.9 (45–81) and Group 2 (PSO) had a mean age of 66.76 years (47–79); 64.7% female versus PSO 76.5%; Body Mass Index (BMI) Group 1 (MOLIF) 28.05 and Group 2 (PSO) 27.17. Group 1 (MOLIF) perioperative neurological injury was 2.94% at discharge but resolved by 6 weeks. Group 2 (PSO) had five neurological deficits (14.7%) with no recovery by 2 years. There were four SCM events (SCM). In Group 1 (MOLIF), there was one event (2.94%) versus three events (8.88%) in Group 2 (PSO). Conclusion. Staged MOLIF avoids passing neurological structures or retraction of psoas and lumbar plexus. It is safer than PSO in CASD with stiff or fused spines with a lower perioperative neurological injury profile. MOLIF have less SCM events, blood loss, and number of levels fused. Level of Evidence: 3

Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

“…A total of 16 studies [13][14][15][18][19][20][21][22][23][24][25][26][27][28][29][30] involving 519 patients underwent OLIF combined with posterior or lateral fixation with or without posterior decompression and PCO were included in the present meta-analysis. All included studies were assessed as good according to the NHLBI quality assessment tool.…”

“…Fifteen studies [13][14][15][18][19][20][21][22][23][24][25][26][27][28][29] involving 491 patients reported gender (145 males and 346 females) and age (mean 67.6 years, 20-86). The mean follow-up of 434 patients in 13 studies [13][14][15][18][19][20][21][22]24,[27][28][29][30] was 22 months (3-64).…”

“…The mean OLIF levels of 370 patients in 12 studies 14,15,[18][19][20][21][22][23][24][25]27,28 was 3.1 segments (1-6, T12-S1). The mean total fusion levels of 491 patients in 15 studies [13][14][15][18][19][20][21][22][23][24][25][26][27][28][29] was 4.9 segments (1-15, T4-S1). The mean fixation levels of 146 patients in 4 studies 14,18,20,27 was 7.2 segments (2-16, T3-S2).…”

“…The mean fixation levels of 146 patients in 4 studies 14,18,20,27 was 7.2 segments (2-16, T3-S2). The mean operative time and intraoperative blood loss of 392 patients in 13 studies [13][14][15][18][19][20][21][22][23][24]26,29,30 were 294.2 min (an average of 59 minutes per fusion level) and 529.3 ml (an average of 107.3 ml per fusion level) respectively. The mean operative time and intraoperative blood loss of 247 patients in 8 studies [13][14][15]18,[20][21][22][23] in OLIF group were 288 min (an average of 75.8 minutes per fusion level) and 366.2 ml (an average of 97.1 ml per fusion level) respectively.…”

Comparisons of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion for degenerative spondylolisthesis: a prospective cohort study with a 2-year follow-up

“…As a minimally invasive approach, oblique lumbar interbody fusion (OLIF) was first introduced by Silvestre et al in 2012 ( 1 ). For patients with lumbar spinal deformity requiring corrective surgery and multiple-level fusion, OLIF is superior to the conventional posterior lumbar fusion techniques, as better angular correction, less blood loss, and less severe surgical trauma were achieved by OLIF ( 2 ).…”