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Wang B, Chen C, Hua W, Ke W, Lu S, Zhang Y, Zeng X, Yang C. Minimally Invasive Surgery Oblique Lumbar Interbody Debridement and Fusion for the Treatment of Lumbar Spondylodiscitis. Orthop Surg 2020; 12:1120-1130. [PMID: 32524753 PMCID: PMC7454224 DOI: 10.1111/os.12711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the efficacy and feasibility of minimally invasive oblique lumbar interbody debridement and fusion for the treatment of conservatively ineffective lumbar spondylodiscitis. Methods This is a retrospective study. Between December 2016 and November 2017, a total of 14 consecutive patients (eight males and six females, with an average age of 49.1 years, range from 42 to 74 years) with single‐level lumbar spondylodiscitis were included in the study. The inclusion criteria include single‐level spondylodiscitis without spinal deformity or epidural abscess, ineffective conservative treatment (continuously aggravated clinical symptoms and uncontrollable infective symptoms treated with antibiotics for more than 6 weeks), minimally invasive oblique lumbar interbody fusion surgery (Mis‐OLIF) and iliac graft for the treatment of lumbar spondylodiscitis, and postoperative follow‐up >12 months. Each patient was treated Mis‐OLIF. Clinical outcomes including demographic characteristics, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), visual analog scale (VAS), the Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. Results The infectious levels included L1/2 (one patient), L2/3 (two patients), L3/4 (eight patients), and L4/5 (three patients). The pathogens found in these patients included Staphylococcus aureus (5), brucellosis (6), and enterobacterium (2). The pathogen was undefined in one patient. The mean duration of the surgery, mean blood loss, and mean follow‐up were 89.3 ± 17.5 min, 155.0 ± 49.4 mL, and 16.8 ± 4.2 months, respectively. The ESR and CRP decreased after Mis‐OLIF and antibiotic administration. The average preoperative VAS score was 6.9 ± 0.9, then decreased to 3.0 ± 1.0 (t = 14.18, P < 0.001) and 0.6 ± 0.7 (t = 20.68, P < 0.001) before discharge and at final follow‐up, respectively. The average preoperative ODI score was 58.4 ± 13.0, then decreased to 28.3 ± 6.1 (t = 18.6, P < 0.001) and 8.0 ± 4.6 (t = 22.7, P < 0.001) before discharge and at final follow‐up, respectively. None of the patients developed postoperative ileus, vascular injury, nerve injury, and ureteral injury. One patient suffered incision‐related complication that healed by debridement and dressing change. One patient developed subsidence of autologous iliac bone before discharge and achieved complete bony fusion after staying in bed and fixing it with a brace at 3 months follow‐up. All patients achieved bony fusion at final follow‐up. Conclusion Mis‐OLIF without anterior or posterior instrumentation and iliac graft is an effective and viable approach for the treatment of conservatively ineffective lumbar spondylodiscitis without spinal deformity or epidural abscess.
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Affiliation(s)
- Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saideng Lu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlin Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fang G, Lin Y, Wu J, Cui W, Zhang S, Guo L, Sang H, Huang W. Biomechanical Comparison of Stand-Alone and Bilateral Pedicle Screw Fixation for Oblique Lumbar Interbody Fusion Surgery-A Finite Element Analysis. World Neurosurg 2020; 141:e204-e212. [PMID: 32502627 DOI: 10.1016/j.wneu.2020.05.245] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The most common complication of oblique lumbar interbody fusion (OLIF) is endplate fracture/subsidence. The mechanics of endplate fracture in OLIF surgery are still unclear. The aim of the present study was to evaluate the biomechanical stability in patients undergoing OLIF surgery with stand-alone (SA) and bilateral pedicle screw fixation (BPSF) methods. METHODS A finite element model of the L1-L5 spinal unit was established and validated. Using the validated model technique, L4-L5 functional surgical models corresponding to the SA and BPSF methods were created. Simulations using the models were performed to investigate OLIF surgery. A 500-N compression force was applied to the superior surface of the model to represent the upper body weight, and a 7.5-Nm moment was applied to simulate the 6 movement directions of the lumbar spinal model: flexion and extension, right and left lateral bending, and right and left axial rotation. Finite element models were developed to compare the biomechanics of the SA and BPSF groups. RESULTS Compared with the range of motion of the intact lumbar model, that of the SA model was decreased by 79.6% in flexion, 54.5% in extension, 57.2% in lateral bending, and 50.0% in axial rotation. The BPSF model was decreased by 86.7% in flexion, 77.3% in extension, 76.2% in lateral bending, and 75.0% in axial rotation. Compared with the BPSF model, the maximum stresses of the L4 inferior endplate and L5 superior endplate were greatly increased in the SA model. The L4 inferior endplate stress was increased to 49.7 MPa in extension, and the L5 superior endplate stress was increased to 47.7 MPa in flexion, close to the yield stress of the lamellar bone (60 MPa). CONCLUSIONS OLIF surgery with BPSF could reduce the maximum stresses on the endplate, which might reduce the incidence of cage subsidence. OLIF surgery with the SA method produced more stress compared with BPSF, especially in extension and flexion, which might be a potential risk factor for cage subsidence.
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Affiliation(s)
- Guofang Fang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Yunzhi Lin
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Jiachang Wu
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Wengang Cui
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Shihao Zhang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Lili Guo
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China
| | - Hongxun Sang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Guangzhou, China.
| | - Wenghua Huang
- Department of Anatomy, Southern Medical University, Guangzhou, China
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Wang Z, Liu L, Xu XH, Cao MD, Lu H, Zhang KB. The OLIF working corridor based on magnetic resonance imaging: a retrospective research. J Orthop Surg Res 2020; 15:141. [PMID: 32293492 PMCID: PMC7158069 DOI: 10.1186/s13018-020-01654-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To provide an anatomical basis for the development of oblique lumbar interbody fusion (OLIF) in Chinese patients. METHODS Between November 2018 and June 2019, 300 patients' lumbar MRI data were reviewed. According to the Moro system and zone method described by us, the axial view was vertically divided into 6 zones (A, I II, III, IV, P) and was horizontally divided into 4 zones (R, a, b, c, L). The locations of left psoas muscle and the major artery at L2/3, L3/4, and L4/5 levels were evaluated by the grid system. The aortic bifurcation segments will also be evaluated at the level of the vertebral body or the disc. RESULTS At the L2/3 level, left psoas muscle and the major artery in zone Ib were found in 28.0% of subjects, in zone IIb in 20.3%, and in zone Ic in 20.0%; at the L3/4 level, in zone Ab in 20.7% of subjects, in zone Ac in 26.0%, and in zone Ic in 11.0%; and at the L4/5 level, areas in zone Ab in 31.0% of subjects, in zone Ac in 26.0%, and in zone Ib in 11.7%. The aortic bifurcation segments were mainly at the L4 level. The zone of the left psoas muscle at all levels, the zone of the major artery at L4/5 level, and the zone of the aortic bifurcation segments had significant correlation with gender difference (P < 0.05). CONCLUSION The left-sided OLIF at L2-L5 disc levels can be a feasible type of surgery for lumbar interbody fusion in the majority of Chinese patients. Before the operation, in order to screen out the appropriate surgical approach, routine lumbar magnetic resonance imaging is recommended to analyze the patient's local anatomical features.
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Affiliation(s)
- Zhe Wang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Lei Liu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang-He Xu
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ming-de Cao
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hai Lu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Kui-Bo Zhang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
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Bae IS, Bak KH, Chun HJ. Interspinous Process Fixation Device Versus Extended Pedicle Screw Fixation for Symptomatic Adjacent Segment Disease: 3-Year Retrospective Study. World Neurosurg 2020; 139:e144-e150. [PMID: 32251823 DOI: 10.1016/j.wneu.2020.03.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the present study, we compared the clinical and radiographic outcomes of an interspinous process fixation device (IFD) with those of extended pedicle screw fixation (PSF) for symptomatic adjacent segment disease (ASD) after lumbar fusion. METHODS The data from 109 patients with ASD treated with IFD (n = 48) or extended PSF (n = 61) from January 2009 to January 2016 were reviewed retrospectively. The clinical outcomes were measured using a visual analog scale (VAS) and the Oswestry disability index. The radiographic outcomes included the fusion rate, incidence of cage subsidence, and additional radiographic ASD. RESULTS The mean incision length, operative time, blood loss, and length of hospital stay were significantly lower in the IFD group (P < 0.001). Postoperative back and leg pain were relieved in both groups (P < 0.001). The mean preoperative VAS scores were 8.3 ± 1.3 and 8.5 ± 1.1 in the IFD and PSF groups and had improved to 2.8 ± 1.1 and 2.7 ± 1.2 after 36 months, respectively (P < 0.001). At 36 months postoperatively, 10 of the 56 patients (17.9%) in the PSF group had developed additional radiographic ASD compared with 2 of 44 patients (4.5%) in the IFD group. CONCLUSION Our results have demonstrated that in the treatment of symptomatic ASD, comparable clinical and radiologic outcomes can be achieved using IFD, which has a shorter skin incision, shorter operative time, less intraoperative blood loss, and shorter hospital stay than the extended PSF technique. Although not statistically significant, the IFD resulted in a lower ASD incidence compare with the PSF technique. Thus, IFD might be an alternative surgical method for symptomatic ASD after lumbar spine fusion.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Nowon-gu, Republic of Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea.
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
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Kirnaz S, Navarro-Ramirez R, Gu J, Wipplinger C, Hussain I, Adjei J, Kim E, Schmidt FA, Wong T, Hernandez RN, Härtl R. Indirect Decompression Failure After Lateral Lumbar Interbody Fusion-Reported Failures and Predictive Factors: Systematic Review. Global Spine J 2020; 10:8S-16S. [PMID: 32528813 PMCID: PMC7263336 DOI: 10.1177/2192568219876244] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In patients with symptomatic lumbar stenosis undergoing lateral transpsoas approach for lumbar interbody fusion (LLIF) surgery, it is not always clear when indirect decompression is sufficient in order to achieve symptom resolution. Indirect decompression failure (IDF), defined as "postoperative persistent symptoms of nerve compression with or without a second direct decompression surgery to reach adequate symptom resolution," is not widely reported. This information, however, is critical to better understand the indications, the potential, and the limitations of indirect decompression. OBJECTIVE The purpose of this study was to systematically review the current literature on IDF after LLIF. METHODS A literature search was performed on PubMed. We included randomized controlled trials and prospective, retrospective, case-control studies, and case reports. Information on sample size, demographics, procedure, number and location of involved levels, follow-up time, and complications were extracted. RESULTS After applying the exclusion criteria, we included 9 of the 268 screened articles that reported failure. A total of 632 patients were screened in these articles and detailed information was provided. Average follow-up time was 21 months. Overall reported incidence of IDF was 9%. CONCLUSION Failures of decompression via LLIF are inconsistently reported and the incidence is approximately 9%. IDF failure in LLIF may be underreported or misinterpreted as a complication. We propose to include the term "IDF" as described in this article to differentiate them from complications for future studies. A better understanding of why IDF occurs will allow surgeons to better plan surgical intervention and will avoid revision surgery.
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Affiliation(s)
- Sertac Kirnaz
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Rodrigo Navarro-Ramirez
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
- These authors contributed equally to this work
| | - Jiaao Gu
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Ibrahim Hussain
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Joshua Adjei
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Eliana Kim
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Taylor Wong
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Roger Härtl
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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Choy W, Mayer RR, Mummaneni PV, Chou D. Oblique Lumbar Interbody Fusion With Stereotactic Navigation: Technical Note. Global Spine J 2020; 10:94S-100S. [PMID: 32528814 PMCID: PMC7263341 DOI: 10.1177/2192568220910181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Surgical technical note. OBJECTIVES Describe the preoperative evaluation, approach, and technical considerations for an oblique lumbar interbody fusion using neuronavigation. METHODS A thorough review of previous technical and anatomic descriptions for pre- and transpsoas interbody techniques was performed and incorporated into the technical considerations warranting discussion for a navigated oblique lateral interbody fusion. RESULTS The prepsoas technique, also known as an oblique lumbar interbody fusion (OLIF), is an alternative approach for lumbar interbody fusion that utilizes a retroperitoneal corridor between the aorta/inferior vena cava. This corridor is devoid of neurovascular structures and obviates the need for real time electromyography monitoring. This approach spares the psoas and provides direct visualization of key structures and minimizes risk of injury to the great vessels, ureter, and lumbar plexus. CONCLUSIONS A navigated prepsoas retroperitoneal approach is an effective minimally invasive technique for lumbar interbody fusion that may help mitigate some of the vascular and neurologic complications present with anterior lumbar interbody fusion or lateral lumbar interbody fusion and minimize radiation exposure to the surgeon.
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Affiliation(s)
| | | | | | - Dean Chou
- University of California San Francisco, CA, USA
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Abed Rabbo F, Wang Z, Sunna T, Newman N, Zairi F, Boubez G, Shedid D. Long-term complications of minimally-open anterolateral interbody fusion for L5-S1. Neurochirurgie 2020; 66:85-90. [PMID: 32197973 DOI: 10.1016/j.neuchi.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiple surgical techniques and approaches exist to obtain lumbar interbody fusion. Anterolateral (oblique) is a relatively recent technique. Controversy exists for its use at the L5-S1 level. We performed this study in order to show the safety and efficacy of this technique. The aim of this study was to report the long-term complications and fusion rates of minimally-open (mini-open) anterolateral interbody fusion at the L5-S1 level. METHODS We retrospectively analyzed all patients who underwent mini-open anterolateral interbody fusion for L5-S1 level in our department. The data collected were the following: age, sex, surgical indication, acute (less than four weeks) and long-term complications (>3 months), fusion at six months and length of follow-up. RESULTS Seventeen patients (8M/9F) underwent mini-open anterolateral interbody fusion at L5-S1. The mean age was 64.5 years. The surgical indication was scoliosis in 10 cases, flat back in 4 cases, and spondylolisthesis in 3 cases. All patients underwent a complementary posterior procedure that included fixation. Mean blood loss was 252.9mL for the anterior procedure. Eight acute and minor complications occurred (anemia, delirium, and psoas paresis). Two acute complications required surgical intervention (cage displacement and hematoma). Long-term complications were observed in 2 cases and included proximal junction kyphosis and non-union. The fusion rate was evaluated at 88%. The mean follow-up period was 28.3 months. CONCLUSIONS Mini-open anterolateral interbody fusion at the L5-S1 level is safe and results in fusion at the same rate as anterior interbody fusion. Most acute complications are minor and resolve spontaneously.
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Affiliation(s)
- F Abed Rabbo
- Service de neurochirurgie B, centre hospitalo-universitaire (CHU) de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Z Wang
- Service d'orthopédie, centre hospitalier de l'université de Montréal (CHUM), 100, rue Saint-Denis, bureau E-368, 3(e) étage, QC H2X 0C1 Montréal, Canada
| | - T Sunna
- Division of neurosurgery, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El Solh Beirut, 1107 2020 Beirut, Lebanon
| | - N Newman
- Service d'orthopédie, centre hospitalier de l'université de Montréal (CHUM), 100, rue Saint-Denis, bureau E-368, 3(e) étage, QC H2X 0C1 Montréal, Canada
| | - F Zairi
- Service de neurochirurgie, Ramsay général de santé, hôpital privé Le Bois, 59000 Lille, France
| | - G Boubez
- Service d'orthopédie, centre hospitalier de l'université de Montréal (CHUM), 100, rue Saint-Denis, bureau E-368, 3(e) étage, QC H2X 0C1 Montréal, Canada
| | - D Shedid
- Service de neurochirurgie, centre hospitalier de l'université de Montréal (CHUM), 1000, rue Saint-Denis, bureau E-368, 3(e) étage, QC H2X 0C1 Montréal, Canada
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Xi Z, Chou D, Mummaneni PV, Burch S. The Navigated Oblique Lumbar Interbody Fusion: Accuracy Rate, Effect on Surgical Time, and Complications. Neurospine 2020; 17:260-267. [PMID: 32054142 PMCID: PMC7136090 DOI: 10.14245/ns.1938358.179] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The oblique lumbar interbody fusion (OLIF) can be done with either fluoroscopy or navigation. However, it is unclear how navigation affects the overall flow of the procedure. We wished to report on the accuracy of this technique using navigation and on how navigation affects surgical time and complications.
Methods A retrospective review was undertaken to evaluate patients who underwent OLIF using spinal navigation at University of California San Francisco. Data collected were demographic variables, perioperative variables, and radiographic images. Postoperative lateral radiographs were analyzed for accuracy of cage placement. The disc space was divided into 4 quadrants from anterior to posterior, zone 1 being anterior, and zone 4 being posterior. The accuracy of cage placement was assessed by placement.
Results There were 214 patients who met the inclusion criteria. A total of 350 levels were instrumented from L1 to L5 using navigation. The mean follow-up time was 17.42 months. The mean surgical time was 211 minutes, and the average surgical time per level was 129.01 minutes. After radiographic analysis, 94.86% of cages were placed within quartiles 1 to 3. One patient (0.47%) underwent revision surgery because of suboptimal cage placement. For approach-related complications, transient neurological symptoms were 10.28%, there was no vascular injury.
Conclusion The use of navigation to perform OLIF from L1 to L5 resulted in a cage placement accuracy rate of 94.86% in 214 patients.
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Affiliation(s)
- Zhuo Xi
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.,Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Shane Burch
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
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He W, He D, Sun Y, Xing Y, Liu M, Wen J, Wang W, Xi Y, Tian W, Ye X. Quantitative analysis of paraspinal muscle atrophy after oblique lateral interbody fusion alone vs. combined with percutaneous pedicle screw fixation in patients with spondylolisthesis. BMC Musculoskelet Disord 2020; 21:30. [PMID: 31937277 PMCID: PMC6961348 DOI: 10.1186/s12891-020-3051-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is no available literature for comparison on muscle atrophy between the "stand-alone" oblique lateral interbody fusion (OLIF) and regular OLIF (i.e., combined with percutaneous pedicle screws fixation (PPSF) in patients with spondylolisthesis). This study aimed to identify changes in back muscle atrophy between the two surgeries. METHODS This was a retrospective cohort study of patients who underwent OLIF or OLIF+PPSF at Beijing Jishuitan Hospital and Shanghai ChangZheng Hospital between 07/2014 and 10/2017. Computed tomography (CT) was used to measure functional cross-sectional area (FCSA) and fat infiltration percentage (FIP) of the multifidus and erector spinae before and 24 months after surgery. RESULT There were no differences in FCSA and FIP between OLIF (n = 32) and OLIF+PPSF (n = 41) groups before surgery. In the OLIF group, the multifidus and erector spinae FCSA and FIP did not change at 24 months (FCSA: multifidus: from 8.59 ± 1.76 to 9.39 ± 1.74 cm2, P = 0.072; erector spinae: from 13.32 ± 1.59 to 13.55 ± 1.31 cm2, P = 0.533) (FIP: multifidus: from 15.91 ± 5.30% to 14.38 ± 3.21%, P = 0.721; erector spinae: from 11.63 ± 3.05% to 11.22 ± 3.12%, P = 0.578). In the OLIF+PPSF group, the multifidus and erector spinae FCSA decreased (multifidus: from 7.72 ± 2.69 to 5.67 ± 1.71 cm2, P < 0.001; erector spinae: from 12.60 ± 2.04 to 10.15 ± 1.82 cm2, P < 0.001), while the FIP increased (multifidus: from 16.13 ± 7.01% to 49.38 ± 20.54%, P < 0.001; erector spinae: from 11.93 ± 3.22% to 22.60 ± 4.99%, P < 0.001). The differences of FCSA and FIP between the two groups at 24 months were significant (all P < 0.001). The patients in the standalone OLIF group had better VAS back pain, and JOA scores than the patients in the OLIF combined group (all P < 0.05) at 1 week and 3 months after surgery. There were two cases (4.9%) of adjacent segment degeneration in the OLIF combined group, while there was no case in the OLIF alone group. CONCLUSIONS Standalone OLIF had better clinical outcomes at 1 week and 3 months than OLIF+PPSF in patients with spondylolisthesis. OLIF may not result in paraspinal muscle atrophy at 24 months after surgery.
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Affiliation(s)
- Wei He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Mingming Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Jiankun Wen
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Weiheng Wang
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Yanhai Xi
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Xiaojian Ye
- Department of Spine surgery, Shanghai ChangZheng Hospital, Shanghai, 200003, China.
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Ramírez León JF, Ardila ÁS, Rugeles Ortíz JG, Martínez CR, Alonso Cuéllar GO, Infante J, Lewandrowski KU. Standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases. JOURNAL OF SPINE SURGERY 2020; 6:S275-S284. [PMID: 32195434 DOI: 10.21037/jss.2019.06.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.
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Affiliation(s)
- Jorge Felipe Ramírez León
- Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.,Research Team, Centro de Columna, Bogotá, Colombia.,Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
| | | | - José Gabriel Rugeles Ortíz
- Research Team, Centro de Columna, Bogotá, Colombia.,Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
| | - Carolina Ramírez Martínez
- Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.,Research Team, Centro de Columna, Bogotá, Colombia.,Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
| | | | | | - Kai-Uwe Lewandrowski
- Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.,Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA
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Wang C, Zeng J, Yang Z. [Guiding role of imaging evaluation in oblique lumbar interbody fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1572-1577. [PMID: 31823561 PMCID: PMC8355787 DOI: 10.7507/1002-1892.201904021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To summarize the guiding role of imaging evaluation of oblique lumbar interbody fusion (OLIF) in recent years. METHODS The reports of OLIF surgical imaging research at home and abroad in recent years were extensively reviewed and analyzed. RESULTS Preoperative imaging evaluation plays an important role in guiding the operation of OLIF, the placement of fusion Cage, the selection of indications, and the reduction of complications. CONCLUSION Detailed preoperative imaging evaluation can correctly estimate the indications of OLIF, and avoid the nerve, blood vessel, and muscle injuries.
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Affiliation(s)
- Chaoyang Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jiancheng Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Zhiqiang Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Tong YJ, Liu JH, Fan SW, Zhao FD. One-stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series. Orthop Surg 2019; 11:1109-1119. [PMID: 31701667 PMCID: PMC6904647 DOI: 10.1111/os.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Surgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis. Methods This was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively. Results The mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05). Conclusion One‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.
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Affiliation(s)
- Yong-Jun Tong
- Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China.,Department of Orthopaedics, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jun-Hui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key laboratory of Musculoskeletal System Degeneration and Degeneration Translational Research of Zhejiang Province, Hangzhou, China
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Magnetic Resonance Imaging Study of Oblique Corridor and Trajectory to L1-L5 Intervertebral Disks in Lateral Position. World Neurosurg 2019; 134:e616-e623. [PMID: 31678316 DOI: 10.1016/j.wneu.2019.10.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study investigated the retroperitoneal oblique corridor and trajectory of L1-L5 as the lateral surgical access to the intervertebral disks in the Chinese population and detected the potential relationship between the corridor or trajectory and vertebral parameters, including disk axis, psoas muscle, and retroperitoneal vessel. METHODS Seventy magnetic resonance imaging studies performed from January 2017 to January 2019 were investigated. The oblique corridor was defined as the distance between the left lateral border of the retroperitoneal vessel and the anterior border of psoas. The trajectory was defined as the distance between the retroperitoneal vessel and lumbar plexus. RESULTS The oblique corridor analysis to L1-L5 disks have the following mean distances: L1-2 13.36 mm, L2-3 13.36 mm, L3-4 12.37 mm, and L4-5 10.36 mm. There was no difference in the L1-L5 corridor between genders. And the position of retroperitoneal vessel was negatively correlated with the corridor width. The trajectory measurements to L1-L5 disks have the following mean distances: L1-2 27.44 mm, L2-3 30.86 mm, L3-4 30.73 mm, and L4-5 24.36 mm. Moreover, the vertebral parameters, including the disk axis and psoas muscle, were positively correlated with the trajectory width. Otherwise, the position of retroperitoneal vessel was negatively correlated with the trajectory width. CONCLUSIONS Compared with previous studies, the safe surgical area of the Chinese is generally smaller than that of Caucasian. The position of the retroperitoneal vessel is the vital potential to limit the corridor and trajectory. Preoperative assessment of vertebral parameters, especially vascular structure, is essential for planning surgical process.
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Analysis of Spino-Pelvic Parameters and Segmental Lordosis with L5-S1 Oblique Lateral Interbody Fusion at the Bottom of a Long Construct in Circumferential Minimally Invasive Surgical Correction of Adult Spinal Deformity. World Neurosurg 2019; 130:e1077-e1083. [DOI: 10.1016/j.wneu.2019.07.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
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Farah K, Leroy HA, Karnoub MA, Obled L, Fuentes S, Assaker R. Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:306-313. [PMID: 31410621 DOI: 10.1007/s00586-019-06107-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). METHODS Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2-L3 to L5-S1 disc spaces were identified. At each level, left psoas surface (in cm2), access corridor (in mm) and vessel movement were calculated in the three positions. Paired t test was used for comparison. RESULTS The mean surface of the left psoas ranged from 7.83 to 17.19 cm2 in the three positions (p > 0.05). From L2-3 to L4-5, in RLD, when the left hip shifted from extension to flexion, nor the access corridor nor vessel movements were significantly different. When the volunteers shifted from supine to RLD position with hip in extension, arteries moved 3.66-5.61 mm to the right (p < 0.05 at L2-3, L3-4 and L5-S1), while the venous structures moved 0.92-4.96 mm (p < 0.05 at L2-3) to the right. When the position shifted from supine to RLD with hip in flexion, the arterial structures moved 0.47-4.88 mm (p < 0.05 at L2-3 and L3-4) to the right, while the venous structures moved - 0.94 to 4.13 mm (p < 0.05 at L2-3 and L3-4) to the right. CONCLUSION Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kaissar Farah
- Department of Neurosurgery, Lille University Hospital, Lille, France. .,Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France.
| | | | | | - Louis Obled
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Stephane Fuentes
- Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Lin GX, Kotheeranurak V, Zeng TH, Mahatthanatrakul A, Kim JS. A longitudinal investigation of the endplate cystic lesion effect on oblique lumbar interbody fusion. Clin Neurol Neurosurg 2019; 184:105407. [PMID: 31398631 DOI: 10.1016/j.clineuro.2019.105407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/20/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine longitudinal effects of changes in endplate cystic lesions on oblique lumbar interbody fusion (OLIF), the relationship between bone healing and endplate cystic lesion changes, and clinical significance of cyst formation. PATIENTS AND METHODS A total of 107 segments in 67 patients who underwent OLIF between January 2013 and July 2016 were examined in this retrospective study. Using computed tomography, radiographic examinations of endplate cystic lesion, positive or negative cyst formation, cage subsidence, and fusion status were performed. Clinical outcomes were measured using visual analogue scale (VAS) pain scores, Oswestry disability index (ODI), and modified Macnab criteria. Outcomes were compared with preoperatively and postoperatively. A logistic regression analysis was performed to evaluate the relationship between measurements for endplate cysts. RESULTS The fusion rate after OLIF was 94.4% at 2-year follow-up, with 86% of cases reporting satisfactory outcome (based on modified Macnab criteria). A significantly higher (P < 0.01) VAS score for back pain was observed in the cystic lesion group than non-cystic lesion group at 6-month follow-up. Cage subsidence significantly increased the risk of non-union (odds ratio [OR]: 17.24; 95% confidence interval [CI]: 1.67-178.09). Positive cyst sign was a significant risk factor for cage subsidence (OR: 8.52; 95% CI: 2.73-26.62) while cage subsidence was also a significant risk factor for positive cyst formation (OR: 8.37; 95% CI: 2.71-25.89). CONCLUSIONS Cystic lesion may increase back pain in the early postoperative period. However, the preoperative cystic lesion does not aggravate a positive cyst formation or affect the final clinical result. Positive cyst formation was a significant risk factor for cage subsidence. In addition, cage subsidence was a significant predictor of non-union. Thus, the authors can speculate that positive cyst sign was potentially an indirect predictor of non-union.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China.
| | - Vit Kotheeranurak
- Spine unit, Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand South Korea.
| | - Teng-Hui Zeng
- Department of Spinal Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, PR China.
| | | | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
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Liu C, Wang J, Zhou Y. Perioperative complications associated with minimally invasive surgery of oblique lumbar interbody fusions for degenerative lumbar diseases in 113 patients. Clin Neurol Neurosurg 2019; 184:105381. [PMID: 31302382 DOI: 10.1016/j.clineuro.2019.105381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe perioperative complications occurring during oblique lumbar interbody fusion (OLIF) assisted by a retractor system for degenerative lumbar diseases. PATIENTS AND METHODS The perioperative complications in 113 cases series utilizing a minimally invasive approach were recorded and analyzed. One hundred thirteen patients who received OLIF for degenerative lumbar diseases between November 2014 and February 2017 at a single center were evaluated. The most frequent diagnosis was spondylolisthesis (59 cases, 52.2%), followed by lumbar instability (24 cases, 21.2%), adjacent segmental disease (12 cases, 10.6%), adult degenerative scoliosis (11 cases, 9.8%) and discogenic low back pain (7 cases, 6.2%). One hundred thirty-four levels were treated, 88.5% one-level, 4.4% two-level, and 7.1% three-level surgeries. The most fused level was L4-5 (94 levels, 70.2%), followed by L3-4 (31 levels, 23.1%), and L2-3 (9 levels, 6.7%). RESULTS All perioperative complications only included adverse events related to the OLIF procedure. The most observed complications were donor-site pain (24 cases, 21.2%), followed by vertebral endplate fracture (15 cases, 13.3%), thigh numbness/pain (12 cases, 10.6%), psoas/quadriceps weakness (5 cases, 4.4%), sympathetic nerve injury (2 case, 1.8%), paralytic ileus (one case, 0.9%), segmental artery injury (one case, 0.9%), intervertebral infection (one, 0.9%), and contralateral femoral nerve palsy (one, 0.9%). All complications, including postoperative ipsilateral or contralateral thigh paresthesia, pain, and psoas/quadriceps weakness, were observed when operating at L4-L5. The incidence of complications excluding donor-site pain was 24.8% (28/113 cases). The patients with donor-site pain, thigh numbness/pain, psoas/quadriceps weakness, sympathetic nerve injury and paralytic ileus recovered within two months following surgery. The patient with intervertebral infection recovered at 3 months after surgery. One case of contralateral femoral nerve palsy recovered completely with no residual sensory or motor deficit at 6 months. CONCLUSIONS OLIF performed using a retractor system is a validated option to treat a wide spectrum of degenerative lumbar diseases with few perioperative complications and a quick recovery. Judicious use of this technique at the L4/5 level is recommended. Close attention to detail during the procedure can minimize complications that may be associated with the learning curve.
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Affiliation(s)
- Chao Liu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Military Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China
| | - Jian Wang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Military Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China.
| | - Yue Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Army Military Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China
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Hah R, Kang HP. Lateral and Oblique Lumbar Interbody Fusion-Current Concepts and a Review of Recent Literature. Curr Rev Musculoskelet Med 2019; 12:305-310. [PMID: 31230190 PMCID: PMC6684701 DOI: 10.1007/s12178-019-09562-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications. METHODS A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. RECENT FINDINGS Transient neurological deficit, particularly sensorimotor symptoms of the ipsilateral thigh, remains the most common complication seen in LLIF. Best available current literature demonstrates that approximately 30-40% of patients have postoperative deficits, primarily of the proximal leg. Permanent symptoms are less common, affecting 4-5% of cases. Newer techniques to reduce this rate include different retractors, direct visualization of the nerves, and intraoperative neuromonitoring. OLIF may have lower deficit rates, but the available literature is limited. Subsidence rates in both LLIF and OLIF are comparable to ALIF (anterior lumbar interbody fusion), but further study is required. Supplemental posterior fixation is an active area of investigation that shows favorable biomechanical results, but additional clinical studies are needed. Minimally invasive lumbar interbody fusion techniques continue to advance rapidly. As these techniques continue to mature, evidence-based risk-stratification systems are required to better guide both the patient and clinician in the joint decision-making process for the optimal surgical approach.
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Affiliation(s)
- Raymond Hah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 5400, Los Angeles, CA 90033 USA
| | - H. Paco Kang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 5400, Los Angeles, CA 90033 USA
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The Anatomic Characteristics of the Retroperitoneal Oblique Corridor to the L1-S1 Intervertebral Disc Spaces. Spine (Phila Pa 1976) 2019; 44:E697-E706. [PMID: 30475333 DOI: 10.1097/brs.0000000000002951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVE To investigate the oblique corridor to the L1-S1 intervertebral disc space between the psoas muscle and the great vessels in cadaveric specimens bilaterally and the location of genitofemoral nerve and the diaphragmatic crura relative to the oblique corridor. SUMMARY OF BACKGROUND DATA Although use of oblique lumbar interbody fusion is rapidly expanding, the morphometric data related to the procedure are limited. METHODS Twelve fresh-frozen full-torso cadaveric specimens were dissected to examine the oblique corridor to access the L1-S1 space in a static state and with mild retraction of the psoas. The level at which the genitofemoral nerve pierces from the psoas major and the diaphragmatic crura originate from the lumbar vertebral body was also investigated. RESULTS The mean width of oblique corridor in the static state and with mild psoas retraction, respectively, were as follows: on the right side: (L1-2) 13.33 and 16.75 mm; (L2-3) 15.42 and 21.42 mm; (L3-4) 16.58 and 22.67 mm; (L4-5) 12.75 and 21.17 mm; (L5-S1) 5.92 and 12.00 mm; on the left side: (L1-2) 16.75 and 19.67 mm; (L2-3) 18.50 and 25.33 mm; (L3-4) 20.58 and 28.00 mm; (L4-5) 18.17 and 26.08 mm; and (L5-S1) 5.83 and 12.00 mm. The level at which the genitofemoral nerve pierces from the psoas major was between L2 and L4. The diaphragmatic crura originates from L1 to L3. CONCLUSION The oblique corridor allows access to the L1-L5 discs from both sides, but it is larger on the left side. The corridor between the iliac vessels and the psoas for L5-S1 is difficult to be applied clinically. Mild psoas retraction can moderately enlarge the oblique corridor. The genitofemoral nerve and diaphragmatic crura may be encountered in this approach and should be carefully observed. LEVEL OF EVIDENCE 5.
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Kim WJ, Lee JW, Kim SM, Park KY, Chang SH, Song DG, Choy WS. Precautions for Combined Anterior and Posterior Long-Level Fusion for Adult Spinal Deformity: Perioperative Surgical Complications Related to the Anterior Procedure (Oblique Lumbar Interbody Fusion). Asian Spine J 2019; 13:823-831. [PMID: 31154755 PMCID: PMC6773981 DOI: 10.31616/asj.2018.0304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/01/2019] [Indexed: 12/02/2022] Open
Abstract
Study Design Retrospective, single-center study. Purpose We aimed to determine the perioperative complications of oblique lumbar interbody fusion (OLIF) as a first-stage procedure in combined anterior and posterior operation for adult spinal deformity (ASD) along with sagittal imbalance. Specifically, we aimed to identify the radiological and clinical types of perioperative surgical complications and the factors affecting these complications. Overview of Literature OLIF has recently gained popularity, and there are several reports of good outcomes and only a few of complications with OLIF; however, a few studies have focused on the perioperative surgical complications of ASD along with sagittal imbalance. Methods The perioperative period was a 1-week interval between the anterior and posterior procedures. All patients underwent simple radiography and magnetic resonance imaging preoperatively and postoperatively. Cage placement was evaluated for displacement (i.e., subsidence and migration) and vertebral body fracture. Clinical patient complaints were evaluated perioperatively. Student t-test was used for data analysis. Results A total of 46 patients were included, totaling 138 fusion segments. A week after OLIF, 14 patients/33 segments (30.4%/23.9%) demonstrated endplate injury-associated cage placement change. Subsidence was the most common cage placement-related complication. As compared with patients without endplate injury, those with endplate injuries showed significantly larger correction angles and a higher proportion of them had larger height cages than the disk height in the full-extension lateral view. Although 32.6% of the patients experienced perioperative clinical complications, they were relatively minor and transient. The most common complication was severe postoperative pain (Visual Analog Scale score of >7), and hip flexor weakness spontaneously resolved within 1 week. Conclusions OLIF yielded more than expected endplate injuries from treatment modalities for ASD along with sagittal imbalance. Therefore, surgeons should be cautious about endplate injury during OLIF procedures. It is difficult to accomplish lordosis correction via OLIF alone; therefore, surgeons should not attempt this impractical correction goal and insert an immoderate cage.
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Affiliation(s)
- Whoan Jeang Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jae Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Su Min Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kun Young Park
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Shann Haw Chang
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Dae Geon Song
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
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Anatomic Considerations in the Lateral Transpsoas Interbody Fusion: The Impact of Age, Sex, BMI, and Scoliosis. Clin Spine Surg 2019; 32:215-221. [PMID: 30520767 DOI: 10.1097/bsd.0000000000000760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective case series. OBJECTIVE Define the anatomic variations and the risk factors for such within the operative corridor of the transpsoas lateral interbody fusion. SUMMARY OF BACKGROUND DATA The lateral interbody fusion approach has recently been associated with devastating complications such as injury to the lumbosacral plexus, surrounding vasculature, and bowel. A more comprehensive understanding of anatomic structures in relation to this approach using preoperative imaging would help surgeons identify high-risk patients potentially minimizing these complications. MATERIALS AND METHODS Age-sex distributed, naive lumbar spine magnetic resonance imagings (n=180) were used to identify the corridor for the lateral lumbar interbody approach using axial images. Bilateral measurements were taken from L1-S1 to determine the locations of critical vascular, intraperitoneal, and muscular structures. In addition, a subcohort of scoliosis patients (n=39) with a Cobb angle >10 degrees were identified and compared. RESULTS Right-sided vascular anatomy was significantly more variant than left (9.9% vs. 5.7%; P=0.001). There were 9 instances of "at-risk" vasculature on the right side compared with 0 on the left (P=0.004). Age increased vascular anatomy variance bilaterally, particularly in the more caudal levels (P≤0.001). A "rising-psoas sign" was observed in 26.1% of patients. Bowel was identified within the corridor in 30.5% of patients and correlated positively with body mass index (P<0.001). Scoliosis increased variant anatomy of left-sided vasculature at L2-3/L3-4. Nearly all variant anatomy in this group was found on the convex side of the curvature (94.2%). CONCLUSIONS Given the risks and complications associated with this approach, careful planning must be taken with an understanding of vulnerable anatomic structures. Our analysis suggests that approaching the intervertebral space from the patient's left may reduce the risk of encountering critical vascular structures. Similarly, in the setting of scoliosis, an approach toward the concave side may have a more predictable course for surrounding anatomy. LEVEL OF EVIDENCE Level 3-study.
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Nagata K, Ando T, Nakamoto H, Kato S, Sasaki K, Oshima Y. Adaptation and limitation of anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. J Orthop Sci 2019; 24:219-223. [PMID: 30318425 DOI: 10.1016/j.jos.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. METHODS We performed a retrospective review of 40 patients diagnosed with pyogenic spondylitis in lower thoracic and lumbar spine who were introduced to our institution due to losing ambulatory ability and underwent anterior column debridement and reconstruction between January 2008 and May 2016. After the patient population was split into a regaining ambulatory group (Group A; n = 23) and a poor prognosis group (Group P; n = 17), we used Fisher exact tests and t-tests as appropriate for univariate analyses to compare patient characteristics and outcomes between the 2 groups. RESULTS Univariate analysis showed that the significant variables were massive bleeding (>2000 ml) (P < 0.01), Charlson Comorbidity Index ≥3 (P = 0.01), and two-stage surgery needed (P = 0.04). Logistic regression analysis showed that the factors associated with poor prognosis were massive bleeding (Odds Ratio 11.9; 95% confidence interval 1.8 to 119.7; P = 0.04). CONCLUSIONS Massive bleeding was associated with poor prognosis after debridement followed by anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.
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Affiliation(s)
- Kosei Nagata
- The University of Tokyo Hospital, Japan; Hitachi General Hospital, Japan.
| | | | | | - So Kato
- The University of Tokyo Hospital, Japan
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Chang SY, Nam Y, Lee J, Chang BS, Lee CK, Kim H. Impact of Preoperative Diagnosis on Clinical Outcomes of Oblique Lateral Interbody Fusion for Lumbar Degenerative Disease in a Single-institution Prospective Cohort. Orthop Surg 2019; 11:66-74. [PMID: 30767389 PMCID: PMC6430477 DOI: 10.1111/os.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/01/2018] [Accepted: 12/13/2018] [Indexed: 01/22/2023] Open
Abstract
Objectives Oblique lateral interbody fusion is considered a useful surgical option for various lumbar degenerative diseases with favorable clinical results and few complications. However, clinical outcomes following oblique lateral interbody fusion stratified according to the preoperative diagnosis have not been fully evaluated in a large cohort. The purpose of the present study was to evaluate the clinical outcomes following oblique lateral interbody fusion for lumbar degenerative disease and to identify differences in outcomes when stratified according to preoperative diagnosis. Methods All patients receiving oblique lateral interbody fusion for lumbar degenerative diseases were included in the current study and were stratified into four diagnostic groups: (i) degenerative spondylolisthesis; (ii) spondylolytic spondylolisthesis; (iii) spinal stenosis without spondylolisthesis and instability; and (iv) deformity. Clinical outcomes were assessed using multiple patient‐reported questionnaires. Radiologic outcomes, including cage subsidence and completion of fusion, were also evaluated. Results Overall, 169 patients with 262 operative levels were included in the study. All clinical scoring items showed significant improvement at 1 year postoperatively for all diagnostic groups. Net and percent improvement, and a proportion of patients reaching a threshold for substantial clinical benefit were not significantly different between the diagnostic groups in all scoring items, except for lower extremity radiating pain of the deformity group. Although the deformity group had the highest overall complication rate, neurologic complications were more frequent in the spondylolytic spondylolisthesis group. The rate of complete fusion and cage subsidence for individual levels at 1 year postoperatively was 62.7% and 32.6% respectively, with no significant difference between the diagnostic groups. Conclusions The large single‐institution prospective cohort of the present study showed favorable clinical outcomes following oblique lateral interbody fusion for lumbar degenerative disease, even in spinal stenosis without spondylolisthesis and instability.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yunjin Nam
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeongik Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Choo-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Zhu G, Hao Y, Yu L, Cai Y, Yang X. Comparing stand-alone oblique lumbar interbody fusion with posterior lumbar interbody fusion for revision of rostral adjacent segment disease: A STROBE-compliant study. Medicine (Baltimore) 2018; 97:e12680. [PMID: 30290656 PMCID: PMC6200540 DOI: 10.1097/md.0000000000012680] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Spinal fusion has become a standard treatment for symptomatic intervertebral degenerative disc disease. The present study aimed to compare perioperative parameters, clinical outcomes, and radiographic results of stand-alone oblique lumbar interbody fusion (OLIF) with posterior lumbar interbody fusion (PLIF) for the revision of rostral adjacent segment disease (ASD) following prior posterior lumbar fusion.Thirty-six patients who underwent revision surgeries for rostral ASD were retrospectively reviewed. Among them, 17 patients underwent stand-alone OLIF (OLIF group) and 19 patients underwent PLIF (PLIF group). The length of operation, intraoperative hemorrhage, bed rest duration, and length of hospital stay were compared between the 2 groups. Clinical results were evaluated with the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiological results were evaluated with disc height (DH), foraminal height (FH), retrolisthesis index (RI), and lumbar lordosis (LL), as well as the fusion rate and cage subsidence. Follow-up results at 1 week, 3 months, and 12 months postoperatively were compared between the 2 groups.The OLIF group had less intraoperative blood loss, shorter operative time, bed rest time, and hospital stay than did the PLIF group (P < .05). The OLIF group had lower VAS scores for back pain than the PLIF group at 1 week and 3 months postoperatively (P < .05), and lower VAS scores for leg pain than the PLIF group at 1 week postoperatively (P < .05). The OLIF group had lower ODI than the PLIF group at 1 week and 3 months postoperatively (P < .05). No significant differences were found in DH and FH between the 2 groups preoperatively (P > .05); the OLIF group showed higher DH and FH than the PLIF group at all time points (P < .05). No significant differences were found in RI and LL between the 2 groups at any time point. All patients achieved fusion at 12 months postoperatively, and cage subsidence was not observed in either group.OLIF is effective and safe for the treatment of rostral ASD following prior posterior lumbar fusion, and is superior to PLIF in terms of perioperative parameters, short-term clinical outcomes, and DH restoration, with similar fusion and reduction rates.
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Affiliation(s)
| | | | - Lei Yu
- Department of Orthopedics
| | | | - Xiaowei Yang
- Department of SICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Doria C, Balsano M, Rampal V, Solla F. Minimally Invasive Far Lateral Lumbar Interbody Fusion: A Prospective Cohort Study. Global Spine J 2018; 8:512-516. [PMID: 30258758 PMCID: PMC6149041 DOI: 10.1177/2192568218756908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To assess rate and degree of interbody bone fusion and evolution in Oswestry Disability index (ODI) and visual analog scale (VAS) of pain after minimally invasive far lateral lumbar interbody fusion. METHODS Twenty-three patients with single-level lumbar instability or degenerative disc were treated by this method and prospectively included. VAS of pain and ODI were evaluated preoperatively and at last follow-up. Computed tomography scan was performed 6 months after surgery to assess interbody fusion. RESULTS Between preoperative and 2 years postoperative follow-up, mean VAS decreased by 2.4 points (P < .001); mean ODI improved by 21.8% (P < .001). Computed tomography scan showed fusion in all patients but one. No severe complications were observed. CONCLUSIONS Minimally invasive far lateral lumbar interbody fusion resulted in satisfactory clinical and radiological results.
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Affiliation(s)
| | | | | | - Federico Solla
- Hôpital Pédiatrique de Nice CHU-Lenval, Nice, France,Federico Solla, Orthopaedic Surgery, Lenval
University Children's Hospital 57, Avenue de la Californie, 06200 Nice, France.
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77
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Huang C, Xu Z, Li F, Chen Q. Does the Access Angle Change the Risk of Approach-Related Complications in Minimally Invasive Lateral Lumbar Interbody Fusion? An MRI Study. J Korean Neurosurg Soc 2018; 61:707-715. [PMID: 29940723 PMCID: PMC6280061 DOI: 10.3340/jkns.2017.0296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the potential risk of approach-related complications at different access angles in minimally invasive lateral lumbar interbody fusion. METHODS Eighty-six axial magnetic resonance images were obtained to analyze the risk of approach-related complications. The access corridor were simulated at different access angles and the potential risk of neurovascular structure injury was evaluated when the access corridor touching or overlapping the corresponding structures at each angle. Furthermore, the safe corridor length was measured when the corridor width was 18 and 22 mm. RESULTS When access angle was 0°, the potential risk of ipsilateral nerve roots injury was 54.7% at L4-L5. When access angle was 45°, the potential risk of abdominal aorta, contralateral nerve roots or central canal injury at L4-L5 was 79.1%, 74.4%, and 30.2%, respectively. The length of the 18mm-wide access corridor was largest at 0° and it could reach 44.5 mm at L3-L4 and 46.4 mm at L4-L5. While the length of the 22 mm-wide access corridor was 42.3 mm at L3-L4 and 44.1 mm at L4-L5 at 0°. CONCLUSION Changes in the access angle would not only affect the ipsilateral neurovascular structures, but also might adversely influence the contralateral neural elements. It should be also noted to surgeons that alteration of the access angle changed the corridor length.
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Affiliation(s)
- Chunneng Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengkuan Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fangcai Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qixin Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Tu Z, Li L, Wang B, Li Y, Lv G, Dai Y. Stand-Alone Anterolateral Interbody Fusion Versus Extended Posterior Fusion for Symptomatic Adjacent-Segment Degeneration: A Retrospective Study of 2 Years' Follow-up. World Neurosurg 2018; 115:e748-e755. [PMID: 29729460 DOI: 10.1016/j.wneu.2018.04.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the clinical and radiologic outcome of stand-alone anterolateral lumbar interbody fusion (ALLIF) using self-locked cages in comparison with extended posterior lumbar interbody fusion (PLIF) for symptomatic adjacent-segment degeneration (ASD) after posterior lumbar fusion. METHODS This retrospective study enrolled 40 symptomatic patients with ASD who were treated with ALLIF (n = 13) or extended PLIF (n = 27) between January 2011 and January 2015. Evaluations were performed preoperatively, at 3, 12, and 24 months postoperatively. Clinical outcome measurements included visual analog scale scores for low-back and leg pain, Oswestry Disability Index score for function assessment, Short-Form 36 Questionnaire for quality of life, and modified Macnab criteria for patient satisfaction. Radiologic outcome measurements included fusion rate, cage subsidence, disc height, and lumbar lordosis. RESULTS There were no significant differences in the baseline data for the ALLIF and PLIF groups (P > 0.05). Mean operative time, blood loss, and length of hospital stay were significantly decreased for the ALLIF group (P < 0.05). Postoperatively, low back and leg pain was relieved, function and quality of life were improved in both groups (P < 0.05), whereas disc height and lumbar lordosis were restored (P < 0.05). At 24-month follow-up, fusion was observed in 13 of 13 patients (100%), with 3 of 13 (23.1%) patients developing cage subsidence in the ALLIF group. CONCLUSIONS Stand-alone ALLIF could achieve satisfactory safety and efficacy for the treatment of symptomatic ASD with less trauma and faster recovery, and it may serve as an alternative surgical treatment for symptomatic ASD with appropriate indication.
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Affiliation(s)
- Zhiming Tu
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Yawei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuliang Dai
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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DiGiorgio AM, Edwards CS, Virk MS, Mummaneni PV, Chou D. Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series. Neurosurg Focus 2018; 43:E14. [PMID: 28760040 DOI: 10.3171/2017.5.focus17168] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior lumbar interbody fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral lumbar interbody fusion in a series of 49 patients.
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Affiliation(s)
- Anthony M DiGiorgio
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and.,Department of Neurosurgery and
| | - Caleb S Edwards
- School of Medicine, University of California, San Francisco, California
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Quillo-Olvera J, Lin GX, Jo HJ, Kim JS. Complications on minimally invasive oblique lumbar interbody fusion at L2-L5 levels: a review of the literature and surgical strategies. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:101. [PMID: 29707550 DOI: 10.21037/atm.2018.01.22] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fusion is the cornerstone in the treatment of an unstable degenerative lumbar spinal disease. Various techniques have been developed. Amongst these techniques exists the oblique lumbar interbody fusion (OLIF), which is the ante-psoas approach. Adequate restoration of disc height with large cages placed in the intervertebral space, indirect decompression, and correction of sagittal and coronal alignment can be achieved with OLIF procedure with the advantage of minimal risk for the psoas muscle and lumbar plexus. Nevertheless, this technique entails complications directly associated with the anatomical location where the fusion takes place. This surgical area is a window between the left lateral border of the aorta, or the left common iliac artery, and the anterior belly of the left psoas muscle. Vascular complications associated with the injury of the main vessels, segmental artery or iliolumbar vein of the lumbar spine have been reported, as well as urologic lesions due to ureter transgression, amongst others. Although these complications have been described in the literature, an article that complements this information with technical advice for its avoidance is yet to be published. This article is a review of the most frequent complications associated with the OLIF procedure in L2-L5 lumbar levels, as well as a description of technical strategies for the prevention of such complications.
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Affiliation(s)
- Javier Quillo-Olvera
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Guang-Xun Lin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun-Jin Jo
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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81
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Miller C, Gulati P, Bandlish D, Chou D, Mummaneni PV. Prepsoas oblique lateral lumbar interbody fusion in deformity surgery. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:108. [PMID: 29707557 DOI: 10.21037/atm.2018.03.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Interbody fusions are routinely used in deformity surgery to achieve both coronal and sagittal correction and attain increased fusion rates. Minimally invasive interbody techniques, including the prepsoas approach, are being utilized to decrease tissue disruption, blood loss, and patient morbidity with similar outcomes compared to traditional surgery. The prepsoas oblique lateral interbody fusion, accesses the spine between the iliac arteries or aorta and psoas muscle, and allows for exposure of the lumbar spine while avoiding some complications commonly seen with a direct lateral approach. Navigation can assist the surgeon for surgical planning, ensuring appropriate placement of the interbody graft, and with placement of posterior pedicle screws. In correctly selected patients, these minimally invasive procedures can achieve excellent deformity correction and outcomes.
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Affiliation(s)
- Catherine Miller
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Puneet Gulati
- Department of Neurological Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Deepak Bandlish
- Department of Neurological Surgery, SBKS Medical College, Vadodara, India
| | - Dean Chou
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA
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Jin C, Jaiswal MS, Jeun SS, Ryu KS, Hur JW, Kim JS. Outcomes of oblique lateral interbody fusion for degenerative lumbar disease in patients under or over 65 years of age. J Orthop Surg Res 2018; 13:38. [PMID: 29463273 PMCID: PMC5819281 DOI: 10.1186/s13018-018-0740-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/05/2018] [Indexed: 12/05/2022] Open
Abstract
Background Oblique lateral interbody fusion (OLIF) offers the solution to problems of anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF). However, OLIF technique for degenerative spinal diseases of elderly patients has been rarely reported. The objective of this study was to determine the clinical and radiological results of OLIF technique for degenerative spinal diseases in patients under or over 65 years of age. Methods Sixty-three patients who underwent OLIF procedure were enrolled, including 29 patients who were less than 65 years of age and 34 patients who were over 65 years of age. Fusion rate, change of disc height and lumbar lordotic angle, Numeric Rating Scale (NRS), return to daily activity, patient’s satisfaction rate (PSR), and Oswestry disability index (ODI) were used to assess clinical and functional outcomes. Results The mean NRS scores for back and leg pain decreased, respectively, from 4.6 and 5.9 to 2.3 and 1.8 in the group A (less than 65 years) and from 4.5 and 6.8 to 2.6 and 2.2 in the group B (over 65 years) at the final follow-up period. The mean ODI scores improved from 48.4 to 24.0% in the group A and from 46.5 to 25.2% in the group B at the final follow-up period. In both groups, the NRS and ODI scores significantly changed preoperatively to postoperatively (p < 0.001). However, statistical analysis yielded no significant difference in postoperative NRS/ODI scores between two groups. In both groups, the changes in the disc height, segmental lordosis, and fusion rate between the preoperative and postoperative periods were significant. The amount of change between preoperative and postoperative disc height, segmental lordosis, and whole lumbar lordosis demonstrated significant intergroup differences (p < 0.05). Overall perioperative complications occurred in 8 of 29 (27.6%) patients in the group A and in 10 of 34 (29.4%) patients in the group B. In both groups, the major complication incidence was 0 and 3%, respectively. Conclusion Although there was the slightly high incidence of complication associated with high rate of co-morbidities in elderly patients, OLIF for degenerative lumbar diseases in elderly patients showed favorable clinical and radiological outcomes.
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Affiliation(s)
- Chengzhen Jin
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Milin S Jaiswal
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sin-Soo Jeun
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kyeong-Sik Ryu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung-Woo Hur
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea.
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Julian Li JX, Mobbs RJ, Phan K. Morphometric MRI Imaging Study of the Corridor for the Oblique Lumbar Interbody Fusion Technique at L1-L5. World Neurosurg 2017; 111:e678-e685. [PMID: 29294391 DOI: 10.1016/j.wneu.2017.12.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior lumbar interbody fusion and lateral lumbar interbody fusion are associated with approach-related disadvantages. Oblique lumbar interbody fusion (OLIF) is the proposed solution, especially for upper lumbar levels. We analyzed the size and regional anatomy of the corridor used in the OLIF technique between levels L1 and L5. METHODS This is a morphometric study of 200 randomly selected magnetic resonance imaging (MRI) studies with features of lumbar degenerative disease. On MRI, the oblique corridor was defined as the smallest distance between the psoas major muscle and aorta or inferior vena cava (or common iliac artery) and measured at the L1/L2, L2/L3, L3/L4, and L4/L5 disc levels on both the left and right on the axial images at the mid-disc level. RESULTS Mean distances of the oblique corridor on the left side were L1/L2 = 18.90 mm, L2/L3 = 15.50 mm; L3/L4 = 12.75 mm, and L4/L5 = 8.92 mm; on the right side, they were L1/L2 = 14.80 mm, L2/L3 = 5.50 mm, L3/L4 = 3.00 mm, and L4/L5 = 1.46 mm. For both sides, the corridor size was not significantly affected by sex, and it increased with age and decreased at the inferior lumbar disc levels. The L1/L2 and L2/L3 levels may be obstructed by the ipsilateral kidney and renal vasculature on both sides and the liver on the right side. CONCLUSIONS A left-sided OLIF approach is viable for both sexes. Oblique access to the L1/L2 and L2/L3 disc levels is feasible regardless of age, whereas the L3/L4 and L4/L5 levels may be more suitable in older patients, especially for male patients. The right-sided approach is less likely to be performed effectively.
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Affiliation(s)
- Jia Xi Julian Li
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia
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Sato J, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kuniyoshi K, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Fujimoto K, Shiga Y, Abe K, Kanamoto H, Inoue G, Takahashi K. Answer to the Letter to the Editor of Wang Kai et al. concerning "Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis" by Jun Sato et al. Eur Spine J (2017) 26:671-678. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:240-241. [PMID: 29058136 DOI: 10.1007/s00586-017-5326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jun Sato
- Department of Orthopaedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aobachou Chuo-ku, Chiba, Chiba, 260-0852, Japan. .,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Gou Kubota
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takeshi Sainoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroto Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
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Rutter G, Phan K, Smith A, Stewart F, Seex K, Gragnaniello C. Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study. JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:419-425. [PMID: 29057352 PMCID: PMC5637199 DOI: 10.21037/jss.2017.09.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND An approach to lateral lumbar interbody fusion (LLIF) utilizing an oblique corridor anterior to the psoas muscle was first described by Mayer in 1997 and subsequently by other authors. The only consistent structure of note in this corridor is the lumbar sympathetic trunk (LST), which at times must be mobilized in order to perform a discectomy and interbody fusion, thereby placing the LST at risk. This study was designed to describe the morphometric anatomy of the LST in relation to surgically relevant landmarks for the anterolateral approach to the lumbar spine at L3/L4 to L5/S1. METHODS Twenty-four embalmed cadavers (13 males, 11 females, age range, 50-89) were dissected to expose the LST. Bilateral measurements were recorded using a calliper under direct visualization, using the midsagittal plane of the lumbar spine as the reference landmark. The points were then marked with radio-opaque needles, and 14 cadavers were scanned with CT to validate the measurements. RESULTS Of 48 LSTs, there was minimal difference in the direction of its course between sides; 14/24 specimens had concordant directions. The majority (n=28) had a medial to lateral cephalocaudal course. If osteophytes were present at the L4/L5 level, the majority of LSTs (n=7, of 8) were displaced lateral to the osteophyte. At the L5/S1 level, half of the cases with osteophytes (n=3, of 6) stretched the LST over the top of the osteophyte. The LST was adherent to the L4/L5 disc space bilaterally in 93% of cases. CONCLUSIONS With the development of lumbar fusion techniques which utilize an oblique corridor and the retraction of psoas muscle, LST has become an important neural structure to define, protect and mobilize. In our morphometric analysis of 24 specimens, the position has been identified and quantified, and this paper notes variations, particularly distortions caused by degenerative processes. In this study, the LST ran in a medial to lateral direction from L3 to S1, and osteophytes typically displace and adhere to the LST.
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Affiliation(s)
- Gareth Rutter
- School of Medicine, University of New England, Armidale, NSW, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Randwick, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Adam Smith
- School of Medicine, University of New England, Armidale, NSW, Australia
| | - Fiona Stewart
- School of Medicine, University of New England, Armidale, NSW, Australia
| | - Kevin Seex
- Macquarie Neurosurgery, Australian School of Advanced Medicine, Macquarie University Hospital, Macquarie University, NSW, Sydney, Australia
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86
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Kim JS, Jin C. Letter to the Editor concerning “Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF)” (by Kevin Phan, Monish Maharaj, Yusuf Assem, Ralph J. Mobbs Journal of Clinical Neuroscience 31 (2016) 23–29). J Clin Neurosci 2017; 41:172. [DOI: 10.1016/j.jocn.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/05/2017] [Indexed: 11/28/2022]
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Preoperative evaluation of left common iliac vein in oblique lateral interbody fusion at L5-S1. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017. [PMID: 28643127 DOI: 10.1007/s00586-017-5176-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Oblique lateral interbody fusion (OLIF) L5-S1 is essentially to perform an anterior lumbar interbody fusion (ALIF) in the lateral position. Because the surgical procedures are performed "obliquely" over the left common iliac vein (LCIV), ensuring that the vein is protected which is particularly important. We aimed to evaluate the configuration of LCIV and its risk of mobilization during anterior approach at L5-S1 segment. METHODS This study involved 65 consecutive patients who underwent anterior lumbar fusion (ALIF, n = 39; OLIF, n = 26) at the L5-S1 segment. Three independent examiners evaluated the configuration of the LCIV at the L5-S1 disc on axial magnetic resonance images of the lumbar spine. The LCIV was categorized into three types according to the difficulty of mobilization: type I (no requirement for mobilization; LCIV runs laterally for more than two-thirds of the length of the left side of the L5-S1 disc), type II (easy mobilization; LCIV obstructs the L5-S1 disc space, but the perivascular adipose tissue is present under the LCIV), and type III (potentially difficult mobilization; no perivascular adipose tissue under the LCIV). The patient records were reviewed for vascular complications. RESULTS There were 21 men and 44 women in this study, with a mean age of 63.4 years (range 19-83 years). Type I LCIV configuration was found in 32 (49.2%) patients, type II in 18 (27.7%), and type III in 15 (23.1%). There were 7 (10.8%) patients with LCIV injury (type I, n = 0; type II, n = 2; type III, n = 5) (P = 0.003). Intraobserver reliability for the LCIV classification ranged from substantial to excellent, and interobserver reliability ranged from moderate to excellent. CONCLUSIONS Preoperative evaluation for anterior approach to the L5-S1 segment should take account of the LCIV position, as well as the difficulty of its mobilization. The type III LCIV configuration showed a high rate of vascular injury.
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In Reply to "Oblique Lumbar Interbody Fusion: Utility and Perioperative Complications". World Neurosurg 2017; 102:692. [PMID: 28582836 DOI: 10.1016/j.wneu.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 11/21/2022]
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Satyarthee GD. Oblique Lumbar Interbody Fusion: Utility and Perioperative Complications. World Neurosurg 2017; 102:690-691. [DOI: 10.1016/j.wneu.2017.03.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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Mini-open oblique lumbar interbody fusion (OLIF) approach for multi-level discectomy and fusion involving L5-S1: Preliminary experience. Orthop Traumatol Surg Res 2017; 103:295-299. [PMID: 28089666 DOI: 10.1016/j.otsr.2016.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 11/13/2016] [Accepted: 11/22/2016] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Technical description and single institution retrospective case series. OBJECTIVE Evaluate technical feasibility and evaluate complications of mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) at the L5-S1 level. SUMMARY OF BACKGROUND The mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) approach was first described in 2012 as a surgical approach to achieve spinal fusion while limiting invasiveness of the exposure to the anterior lumbar spine. Surgeons who use this approach, along with those who described it in cadaveric studies describe it as a feasible approach in targeting the L2 down to the L5 level and recommend alternative approaches to the L5-S1 level due to the vascular challenges and possible complications. METHODS Technical description and single institution case series of patients treated with the OLIF between 2013 and 2015 at the L5-S1 level. The previously described surgical approach was modified by identifying and ligating the iliolumbar vein before retracting the iliac artery and vein anteriorly instead of passing between the vessels. RESULTS Six patients (3 males, 3 females, mean age 62 years) were operated between 2013 and 2015. There were no vascular injuries or peripheral nerve trauma associated with the surgical procedure. Complications associated with the procedure included: cage displacement immediately postoperative requiring re-operation in one patient, transient psoas weakness in one patient, extended hospital stay for pain control in one patient, and transfusion was required in one patient. CONCLUSIONS Mini-open retroperitoneal oblique lumbar interbody fusion is feasible at the L5-S1 level with limited vascular complications through a technical modification for safe mobilization of the iliac vessels by first ligating the iliolumbar vein.
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Li JXJ, Phan K, Mobbs R. Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications. World Neurosurg 2016; 98:113-123. [PMID: 27777161 DOI: 10.1016/j.wneu.2016.10.074] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are commonly used approaches for lumbar spine fusion surgery, each with their own unique advantages and disadvantages. ALIF requires mobilization of the great vessels and peritoneum, and dissection of the psoas muscle in the LLIF technique is associated with postoperative neurologic complications in the proximal lower limb. The anterior-to-psoas (ATP) or oblique lumbar interbody fusion (OLIF) technique is the proposed solution to accessing the L1-L5 levels without the issues encountered with ALIF and LLIF. In this review, the technical nuances, operative outcomes, and complications with the ATP/OLIF technique in the current literature are summarized. METHODS A systematic search of the literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data collected included operative time, blood loss, postoperative hospital stay, and complications, which were then pooled together. RESULTS From the 16 studies selected, the mean blood loss was 109.9 mL, average operating time was 95.2 minutes, and mean postoperative hospital stay was 6.3 days. Fusion was achieved in 93% of levels operated. Incidence of intraoperative and postoperative complications was 1.5% and 9.9%, respectively. Transient thigh pain and/or numbness and hip flexion weakness occurred in 3.0% and 1.2% of patients, respectively. CONCLUSIONS Early results on the ATP/OLIF technique are promising and warrant further investigation with well-designed prospective randomized studies to provide high-level evidence of the potential advantages over the ALIF and LLIF approaches.
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Affiliation(s)
- Jia Xi Julian Li
- NeuroSpine Surgery Research Group (NSURG), NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, NSW, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, NSW, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ralph Mobbs
- NeuroSpine Surgery Research Group (NSURG), NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, NSW, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.
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