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

Narita, Wataru; Takatori, Ryota; Nagae, Masateru; Tonomura, Hitoshi; Hayashida, Tatsuro; Ogura, Taku; Fujiwara, Hiroyoshi; Kubo, Toshikazu

doi:10.3171/2016.1.spine151069

Cited by 14 publications

(7 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,20,34 Given the risk of neurological complications, several strategies for reducing postoperative neural injury during LLIF have been presented in the literature. These range from novel finger electrode usage for intraoperative monitoring, 19 triggered intermittent electromyography monitoring during psoas retraction, 31 saphenous nerve somatosensory evoked potential monitoring 28 to complete avoidance of the transpsoas technique utilizing a prepsoas oblique lateral corridor for access to the disc space.…”

Section: Discussionmentioning

confidence: 99%

“…This is generally due to difficulty with venous mobilization or retroperitoneal scarring, whereas disruption of the lumbar paraspinal musculature and the nerve root injury secondary to cage insertion are problematic complications of the posterior lumbar interbody fusion and transforaminal lumbar interbody fusion procedures. 19 Because of its ability to provide indirect decompression without disrupting the posterior elements, segmental stability, and lordosis restoration, the transpsoas LLIF technique has been proposed as a treatment option for DS at L4-5. 1,11,15,25,27 However, concerns exist about the rate of neurological complications associated with the lateral approach.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Campbell¹,

Nunley

Cavanaugh³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVERecently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4–5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4–5 level.METHODSThe authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months.RESULTSFifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively.CONCLUSIONSThis study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4–5. The use of this surgical approach provides a minimally invasive solution that offers excellent arthrodesis rates as well as favorable clinical and radiological outcomes, with low rates of postoperative complications. However, adhering to the techniques of transpsoas lateral surgery, such as minimal table break, an initial look-and-see approach to the psoas, clear identification of the plexus, minimal cranial caudal expansion of the retractor, mobilization of any traversing sensory nerves, and total psoas dilation times less than 20 minutes, ensures the lowest possible complication profile for both visceral and neural injuries even in the narrow safe zones when accessing the L4–5 disc space in patients with degenerative spondylolisthesis.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Campbell¹,

Nunley

Cavanaugh³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…If a spinal fusion is indicated, there are several open and minimally invasive approaches to access the spinal column. Open approaches include anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) . There are several challenges to these approaches.…”

mentioning

confidence: 99%

“…Mobilization of the great vessels (eg, aorta, vena cava, iliac arteries and veins) is required and there is potential for blood loss and injury to vasculature and visceral structures as well as postoperative sexual dysfunction in males . With a posterior approach to the spine (eg, TLIF, PLIF), the paraspinal muscles are dissected and the surgeon is limited by the size of the interbody cage (ie, metal or plastic rectangular implants that are placed in the disc space) that he or she can implant because of the spinal structures protecting the spinal cord . Interbody cages are usually porous and allow the bone graft to grow from the vertebral body through the cage and into the next vertebral body.…”

mentioning

confidence: 99%

Patient Care During Minimally Invasive Lateral Spine Surgery

Dufault¹

2018

AORN Journal

View full text Add to dashboard Cite

Perioperative nurses care for patients undergoing a wide range of surgical procedures. One fast-growing surgical specialty is spine surgery performed using minimally invasive techniques. Patients may be candidates for minimally invasive spine surgery based on their presenting signs and symptoms and medical imaging test results. Open anterior and posterior surgical approaches to spine surgery are how surgeons traditionally have performed these procedures. However, new technology has enabled a minimally invasive lateral approach to the spine. This approach minimizes many of the risks and challenges associated with both the anterior and posterior approaches. Minimally invasive lateral interbody fusion requires the perioperative nurse to have a thorough understanding of the necessary patient positioning, spinal anatomy, and OR suite setup to ensure a safe and successful surgical experience for the patient.

show abstract

“…The utility of three-dimensional (3D) image analysis for adolescent idiopathic scoliosis has been recently reported 2,5,6) . Lateral interbody fusion (LIF) such as extreme lateral interbody fusion (XLIF ® ) and oblique lateral interbody fusion (OLIF ) with additional posterior fixation using a percutaneous pedicle screw (PPS) system is an effective and minimally-invasive surgical procedure for treating lumbar spinal deformities caused by multiple intervertebral lesions, compared with interbody fusion via a posterior approach, such as posterior lumbar interbody fusion and transforaminal posterior lumbar interbody fusion [7][8][9] . LIF for adult degenerative scoliosis with lumbar spinal canal/foraminal stenosis is likely to result in satisfactory clinical outcome and fewer complications [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Effect of three-dimensional rotational deformity correction in surgery for adult degenerative scoliosis using lumbar lateral interbody fusion and posterior pedicle screw fixation

Takatori

Ogura

Narita

et al. 2018

Spine Surg Relat Res

Self Cite

View full text Add to dashboard Cite

Abstract:Introduction: Corrective surgery for adult degenerative scoliosis using lateral interbody fusion (LIF) and additional posterior fixation is an efficient procedure. However, it is unclear how this procedure affects rotational deformity correction. Therefore, the goal of the present study was to use three-dimensional (3D) images, taken during surgery, to investigate rotational deformity correction in the treatment of adult degenerative scoliosis using LIF and posterior fixation using a pedicle screw system.Methods: The subjects were 12 females who were treated using LIF and posterior fixation for adult degenerative scoliosis. The patients had a mean age of 72 (65-76) years. 3D images were acquired before surgery, after LIF, and after additional posterior fixation. Rotational angles of the upper vertebra with respect to the lower vertebra of each fixed segment were measured in 3 planes. Correction factors for rotational deformity were investigated after LIF and additional posterior fixation.Results: There were significant improvements in radiographical parameters for global spinal balance. The correction angles per segment were 4.7°for lateral bending, 6.9°for lordosis, and 4.5°for axial rotation. LIF was responsible for correction of four-fifths of lateral bending and axial rotation, and two-thirds of lordotic changes.Conclusions: Lateral bending, axial rotational deformities, and lordosis were primarily corrected by LIF. Further lordosis correction was achieved using additional posterior fixation. These results indicate that corrective surgery for adult degenerative scoliosis using these procedures is effective for rotational deformity correction and leads to an ideal global spinal alignment. Keywords:adult degenerative scoliosis, three-dimensional image analysis, lateral interbody fusion Spine Surg Relat Res 2018; 2(1): 65-71 dx

show abstract

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

Cited by 14 publications

References 25 publications

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Patient Care During Minimally Invasive Lateral Spine Surgery

Effect of three-dimensional rotational deformity correction in surgery for adult degenerative scoliosis using lumbar lateral interbody fusion and posterior pedicle screw fixation

Contact Info

Product

Resources

About