Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series

Abstract

BACKGROUND:Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).OBJECTIVE:To report on the procedural steps and clinical outcomes of the SSLLIF+.METHODS:In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.RESULTS:A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.CONCLUSION:SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.

Commentary: Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series

“…We read with great interest the retrospective case series brought forth by the authors, 1 who should be commended for describing a small case series of lateral lumbar interbody fusion (LLIF) combined with minimally invasive direct microtubular decompression of the lumbar spine in a series of 7 patients with a median follow-up time of 1 year. The authors provided a detailed step-by-step explanation of the procedure and reported no cases requiring conversion to an open procedure, with only 1 revision (14.3%) occurring 20 months after the index procedure because of adjacent segment disease.…”

“…A special consideration was raised by the authors, 1 where the surgeon should be aware of the change in the surgical orientation while performing the microtubular decompression, traditionally performed on patients in prone position. Dealing with a different orientation further emphasizes the unfamiliarity of this procedure to surgeons, which might increase the risk of durotomy and prevent adequate dissection of the ligamentum flavum, and an adequate decompression of the ipsilateral lateral recess.…”

“…In this study, after successfully completing a LLIF with microtubular decompression on 7 patients, the authors delved into the limitations of the procedure, including narrow indications, numerous contraindications, reversed surgical orientation of critical landmarks, and possible misplacement of the tube at a different level. 1 As such, surgeons must take into consideration all listed factors to endure the learning curve required to master this procedure.…”