Postoperative Complications Within the First Year After Extreme Lateral Interbody Fusion

Grimm, Bennett D.; Leas, Daniel; Poletti, Steven C.; Johnson, Donald R.

doi:10.1097/bsd.0000000000000121

Cited by 46 publications

(36 citation statements)

References 31 publications

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“…2,3,7,9,11,12,17,21,24 No serious neurological complications occurred in any patients in the current study, but the incidence of neurological complications of 38.9% in the conventional group was comparatively high, as also seen in past reports. In contrast, the rate of neurological complications of 13% (5 in 36 patients) in the finger electrode group was significantly lower than that in the control group.…”

supporting

confidence: 63%

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Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

Narita

Takatori

Nagae

et al. 2016

SPI

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OBJECTIVE Extreme lateral interbody fusion (XLIF) is a minimally disruptive surgical procedure that uses a lateral approach. There is, however, concern about the development of neurological complications when this approach is used, particularly at the L4–5 level. The authors performed a prospective study of the effects of a new neural monitoring system using a finger electrode to prevent neurological complications in patients treated with XLIF and compared the results to results obtained in historical controls. METHODS The study group comprised 36 patients (12 male and 24 female) who underwent XLIF for lumbar spine degenerative spondylolisthesis or lumbar spine degenerative scoliosis at L4–5 or a lower level. Using preoperative axial MR images obtained at the mid-height of the disc at the treated level, we calculated the psoas position value (PP%) by dividing the distance from the posterior border of the vertebral disc to the posterior border of the psoas major muscle by the anteroposterior diameter of the vertebral disc. During the operation, the psoas major muscle was dissected using an index finger fitted with a finger electrode, and threshold values of the dilator were recorded before and after dissection. Eighteen cases in which patients had undergone the same procedure for the same indications but without use of the finger electrode served as historical controls. Baseline clinical and demographic characteristics, PP values, clinical results, and neurological complications were compared between the 2 groups. RESULTS The mean PP% values in the control and finger electrode groups were 17.5% and 20.1%, respectively (no significant difference). However, 6 patients in the finger electrode group had a rising psoas sign with PP% values of 50% or higher. The mean threshold value before dissection in the finger electrode group was 13.1 ± 5.9 mA, and this was significantly increased to 19.0 ± 1.5 mA after dissection (p < 0.001). A strong negative correlation was found between PP% and threshold values before dissection, but there was no correlation with threshold values after dissection. The thresholds after dissection improved to 11 mA or higher in all patients. There were no serious neurological complications in any patient, but there was a significantly lower incidence of transient neurological symptoms in the finger electrode group (7 [38%] of 18 cases vs 5 [14%] of 36 cases, p = 0.047). CONCLUSIONS The new neural monitoring system using a finger electrode may be useful to prevent XLIF-induced neurological complications.

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confidence: 63%

“…[1][2][3]9,12,[16][17][18]21,24 Reduction of neurological complications is likely to improve the surgical outcome of XLIF and expand the indication. For this reason, we developed a new neural monitoring system using a finger electrode to reach the intervertebral region in patients undergoing XLIF.…”

Section: Discussionmentioning

confidence: 99%

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

Narita

Takatori

Nagae

et al. 2016

SPI

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“…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]. The oblique anterolateral retroperitoneal approach to the lumbar spine passes anterior to the psoas muscle and lateral to the abdominal vessels [11].…”

Section: Discussionmentioning

confidence: 99%

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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“…-0 1 -0% ---Lykissas et al [31] 295 ± 180 ---135% ---Grimm et al [32] 122 -181 -20% -3.0 -Tohmeh et al [33] ----48% ---Berjano et al [34] ----16% ---Lee et al [26] 52 ± 19 -0 [35] 73 ± 31 -< 50 -29% ---Sharma et al [36] ----70% ---Pimenta et al [25] 130 ---28% -1.4 -Ahmadian et al [37] --94 ---3.5 -Caputo et al [38] ----2 ---Malham et al [39] 84 -70 -20% ---Pimenta et al [40] 69 ± 11 -< 50 -13% ---Elowitz et al [41] ----20% 3 ---Oliveira et al [42] cutive, odd/even patient order). In Table 6 [45] polled patients on postoperative day 2, finding a VAS back of 2.2 ± 0.6 in MIS patients and 4.3 ± 0.5, a statistically significant difference (P < 0.05).…”

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confidence: 99%

“…-0 1 -14% ---Nomura et al [22] [23] 102 ± 44 -35 ± 76 -11% -2.1 2.2 Wada et al [24] 144 -60 -7% --- [27] 2014 XLIF Retrospective cohort, XLIF vs ALIF DDD, FBSS, spondylolisthesis 88 120 Smith et al [28] 2012 XLIF Retrospective cohort, XLIF vs ALIF DDD, LSS, FBSS, spondylolisthesis, herniation 115 87 1 Rodgers et al [12] 2010 XLIF Retrospective cohort, XLIF vs PLIF > 80 yr, LSS, FBSS spondylolisthesis, scoliosis, fracture 40 20 Huang et al [29] 2010 MIS-ALIF 2 Prospective cohort, MIS-ALIF vs ALIF Not defined 10 13 Case series 3 Rodgers et al [13] 2011 XLIF PCS LSS, DDD, FBSS, spondylolisthesis, scoliosis 600 -Ruetten et al [30] 2005 XLIF RCS Lumbar disc prolapse 463 -Lykissas et al [31] 2014 XLIF RCS Degenerative spinal conditions 144 -Grimm et al [32] 2014 XLIF RCS DDD, LSS, FBSS, scoliosis, spondylolisthesis, herniation 108 -Tohmeh et al [33] 2011 XLIF PCS LSS, DDD, spondylolisthesis, spondylosis, scoliosis, recurrent herniation, ASD…”

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confidence: 99%

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

Skovrlj¹

2015

WJO

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AIM:To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS). METHODS:A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant. RESULTS:

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Postoperative Complications Within the First Year After Extreme Lateral Interbody Fusion

Cited by 46 publications

References 31 publications

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

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