The effect of vascular approach surgeons on perioperative complications in lateral transpsoas lumbar interbody fusions

Manning, Jordan H.; Wang, Erik; Varlotta, Christopher; Woo, Dainn; Ayres, Ethan W.; Eisen, Leon; Bendo, John A.; Goldstein, Jeffrey A.; Spivak, Jeffrey M.; Protopsaltis, Themistocles S.; Passias, Peter G.; Buckland, Aaron J.

doi:10.1016/j.spinee.2019.10.013

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…Although both anterior lumbar interbody fusion (ALIF) and direct lateral interbody fusion (DLIF) can achieve interbody fusion without damaging the back muscles and ligaments, the transabdominal approach is a huge challenge for most orthopaedists. For example, DLIF via psoas approach has a high complication rate of muscle weakness, lumbar plexus and genitofemoral nerve injury 18,19 . To date, only one complication has been identified in our review of 10 cases.…”

Section: Discussionmentioning

confidence: 94%

“…For example, DLIF via psoas approach has a high complication rate of muscle weakness, lumbar plexus and genitofemoral nerve injury. 18,19 To date, only one complication has been identified in our review of 10 cases. One patient presented with dysesthesia of the left leg that resolved within 2 weeks after surgery, which may be associated with minor injury of the lumbar plexus or psoas traction irritation.…”

Section: Preliminary Outcomementioning

confidence: 99%

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Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

Jia

Dou

Liu

et al. 2022

Orthopaedic Surgery

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Objective: Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation.Methods: This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications.Results: Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m 2 (mean BMI of 27.5 kg/m 2 ). The preoperative claudication distance was 160.00 AE 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 AE 407.70 m and 1040.00 AE 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 AE 0.97 (range 4-7) and 6.40 AE 0.97 (range 5-8). The score on postoperative month 3 was 1.60 AE 0.52 (range 1-2) and 1.20 AE 0.79 (range 0-2), and the 1-year follow-up score was 1.90 AE 0.74 (range 1-3) and 1.60 AE 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 AE 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 AE 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 AE 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 AE 32.5 min vs. 214.9 AE 60.0 min) but the amount of blood loss decreased significantly (113.3 AE 26.7 ml vs. 366.8 AE 298.2 ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up. Conclusion:OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.

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Section: Discussionmentioning

confidence: 94%

Section: Preliminary Outcomementioning

confidence: 99%

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

Jia

Dou

Liu

et al. 2022

Orthopaedic Surgery

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“…The incidence of major vascular injury for the transpsoas group was statistically significantly lower than that of the prepsoas group (0.4% vs 1.8%, p=0.01). Manning et al quite recently reported one patient (0.4%) with iliac vein injury in a series of 275 patients that underwent LLIF [16]. [15].…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, Buric et al reported another case of direct injury and immediate repair of the common iliac vein during an L4-L5 primary XLIF [13]. Few case series and systematic reviews have investigated the number of vascular complications during primary XLIF or LLIF and even fewer authors have reported vascular complications [14][15][16] (Table 2). However, again, no combination of neurovascular complications was reported in the cases that suffered major vascular injuries.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Combined Major Arterial and Lumbar Plexus Injury During Primary Extra Lateral Interbody Fusion: Case Report and Review of the Literature

Mousafeiris

Tsekouras

Korovessis

2021

Cureus

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Extra lateral interbody fusion (XLIF) has been established in recent years as an effective approach to address degenerative lumbar disc disease (DLDD). Although neurological and vascular complications during XLIF have been reported, to our knowledge, a combination of simultaneous vascular and neurovascular complication during XLIF has not been reported to date. A 72-year-old female patient was admitted to our orthopaedic department because of back pain associated with severe neuropathic radicular pain to her both lower extremities, incomplete paraplegia and low back fistula with serous secretion for several weeks. She had been wheelchair bound since nine years before her admission in our department when she had her initial XLIF operation in another institution. Intraoperatively, an aorta lesion occurred, which was emergently addressed, along with lumbar plexus injury. Since then, she had an extensive history of subsequent operations that ended with a T10-S1 posterior lumbar fusion, with no improvement of her neurological condition, complicated by hardware-induced infection. She underwent her last operation in our department; removal of the posterior lumbar construct and extensive debridement of the posterior lumbar spine. We present this rare case and we perform an extensive literature review. Although XLIF has been established in recent years, the report of major vascular injuries, although rare, has questioned its safety profile. Spine surgeons should be aware of catastrophic major neurovascular complications associated with this procedure and be prepared to address them.

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“…Fisher's exact test and the chi-square test were used to compare categorical variables, and the student's t test was used to compare continuous variables. One-to-one propensity score matching [17][18][19] was performed after crude data analysis, and the same analysis was performed on eligible patients only after matching.…”

Section: Statisticsmentioning

confidence: 99%

Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database

Morishita

Yoshii

Inose

et al. 2021

Global Spine Journal

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Study Design Retrospective cohort study. Objectives Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. Methods This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. Results This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. Conclusions More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.

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The effect of vascular approach surgeons on perioperative complications in lateral transpsoas lumbar interbody fusions

Cited by 6 publications

References 37 publications

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

Simultaneous Combined Major Arterial and Lumbar Plexus Injury During Primary Extra Lateral Interbody Fusion: Case Report and Review of the Literature

Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database

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