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Duraffourg M, Rougereau G, Fawaz R, Ltaief A, Jacquesson T, Freydier M, Baude C, Robert R, Mertens P. Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia. Magn Reson Imaging 2024; 112:18-26. [PMID: 38797289 DOI: 10.1016/j.mri.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Diffusion tensor imaging (DTI) is commonly used to establish three-dimensional mapping of white-matter bundles in the supraspinal central nervous system. DTI has also been the subject of many studies on cranial and peripheral nerves. This non-invasive imaging technique enables virtual dissection of nerves in vivo and provides specific measurements of microstructural integrity. Adverse effects on the lumbosacral plexus may be traumatic, compressive, tumoral, or malformative and thus require dedicated treatment. DTI could lead to new perspectives in pudendal neuralgia diagnosis and management. We performed a systematic review of all articles or posters reporting results and protocols for lumbosacral plexus mapping using the DTI technique between January 2011 and December 2023. Twenty-nine articles published were included. Ten studies with a total of 351 participants were able to track the lumbosacral plexus in a physiological context and 19 studies with a total of 402 subjects tracked lumbosacral plexus in a pathological context. Tractography was performed on a 1.5T or 3T MRI system. DTI applied to the lumbosacral plexus and pudendal nerve is feasible but no microstructural normative value has been proposed for the pudendal nerve. The most frequently tracking parameters used in our review are: 3T MRI, b-value of 800 s/mm2, 33 directions, 3 × 3 × 3 mm3, AF threshold of 0.1, minimum fiber length of 10 mm, bending angle of 30°, and 3DT2 TSE anatomical resolution. Increased use of DTI could lead to new perspectives in the management of pudendal neuralgia due to entrapment syndrome, whether at the diagnostic, prognostic, or preoperative planning level. Prospective studies of healthy subjects and patients with the optimal acquisition parameters described above are needed to establish the accuracy of MR tractography for diagnosing pudendal neuralgia and other intrapelvic nerve entrapments.
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Affiliation(s)
- M Duraffourg
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France
| | - G Rougereau
- Service de chirurgie orthopédique et traumatologique Hôpital Pitié Salpetrière, Paris, France
| | - R Fawaz
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Service de Neurochirurgie - Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - A Ltaief
- Service d'imagerie médicale et interventionnelle - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Jacquesson
- Service de Neurochirurgie crânienne générale, tumorale et vasculaire - Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - M Freydier
- Centre d'Évaluation et de Traitement de la Douleur - Centre Hospitalier de Macon, Macon, France; Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - C Baude
- Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - R Robert
- Service de chirurgie - Hôpital Privé du Confluent, Nantes, France; Faculté de Médecine de Nantes, Nantes, France
| | - P Mertens
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
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Jang HD, Lee JC, Choi SW, Hong CH, Suh YS, Shin BJ. A novel surgical approach using the "lateral corridor" for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note. 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 2024; 33:2611-2620. [PMID: 38819738 DOI: 10.1007/s00586-024-08217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases. We aimed to introduce the "lateral corridor" and report the details of the surgical technique with a clinical case series. METHODS We utilized the lateral access route of the left common iliac vein and named it the "lateral corridor", to distinguish the technique from the standard technique (central corridor). The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated. RESULTS Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the "lateral corridor" technique were included. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries. CONCLUSION We introduced the "lateral corridor" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular complications. The "lateral corridor" necessitated ligation of the ILV or ALV in 42.3% of cases. The "lateral corridor" approach appears to be a promising surgical technique, offering feasibility even in instances where the vascular anatomy precludes the employment of the conventional approach.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Chang-Hwa Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Republic of Korea
| | - You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Buckland AJ, Huynh NV, Menezes CM, Cheng I, Kwon B, Protopsaltis T, Braly BA, Thomas JA. Lateral lumbar interbody fusion at L4-L5 has a low rate of complications in appropriately selected patients when using a standardized surgical technique. Bone Joint J 2024; 106-B:53-61. [PMID: 38164083 DOI: 10.1302/0301-620x.106b1.bjj-2023-0693.r2] [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] [Indexed: 01/03/2024]
Abstract
Aims The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. Methods This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively. Results A total of 517 patients were included in the study. Their mean age was 65.0 years (SD 10.3) and their mean BMI was 29.2 kg/m2 (SD 5.5). A mean of 1.2 levels (SD 0.6) were fused with LLIF, and a mean of 1.6 (SD 0.9) posterior levels were fused. Femoral neuropraxia occurred in six patients (1.2%), of which four (0.8%) were LLIF-related and two (0.4%) had persistent symptoms one year postoperatively. Non-femoral neuropraxia occurred in nine patients (1.8%), one (0.2%) was LLIF-related and five (1.0%) were persistent at one year. All LLIF-related neuropraxias resolved by one year. A total of 32 patients (6.2%) had thigh pain, 31 (6.0%) were LLIF-related and three (0.6%) were persistent at one year. Weakness of hip flexion occurred in 14 patients (2.7%), of which eight (1.6%) were LLIF-related and three (0.6%) were persistent at one year. No patients had bowel injury, three (0.6%) had an intraoperative vascular injury (not LLIF-related), and five (1.0%) had ileus. Reoperations occurred in five patients (1.0%) within 30 days, 37 (7.2%) within 90 days, and 41 (7.9%) within one year postoperatively. Conclusion LLIF involving the L4-L5 disc level has a low rate of persistent neurological, psoas-related, and abdominal complications in patients with the appropriate indications and using a standardized surgical technique.
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Affiliation(s)
- Aaron J Buckland
- Melbourne Orthopaedic Group, Melbourne, Australia
- Spine and Scoliosis Research Associates Australia, Melbourne, Australia
- Department of Orthopaedics, NYU Langone Health, New York, New York, USA
| | - Nam V Huynh
- Spine and Scoliosis Research Associates Australia, Melbourne, Australia
| | | | - Ivan Cheng
- Austin Spine Surgery, Austin, Texas, USA
| | - Brian Kwon
- Division of Spine Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
| | | | | | - J A Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, Delaware, USA
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Kramer DE, Woodhouse C, Kerolus MG, Yu A. Lumbar plexus safe working zones with lateral lumbar interbody fusion: a systematic review and meta-analysis. 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 2022; 31:2527-2535. [PMID: 35984508 DOI: 10.1007/s00586-022-07352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/20/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Significant risk of injury to the lumbar plexus and its departing motor and sensory nerves exists with lateral lumbar interbody fusion (LLIF). Several cadaveric and imaging studies have investigated the lumbar plexus position with respect to the vertebral body anteroposterior plane. To date, no systematic review and meta-analysis of the lumbar plexus safe working zones for LLIF has been performed. METHODS This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies reporting on the position of the lumbar plexus with relation to the vertebral body in the anteroposterior plane were identified from a PubMed database query. Quantitative analysis was performed using Welch's t test. RESULTS Eighteen studies were included, encompassing 1005 subjects and 2472 intervertebral levels. Eleven studies used supine magnetic resonance imaging (MRI) with in vivo subjects. Seven studies used cadavers, five of which performed dissection in the left lateral decubitus position. A significant correlation (p < 0.001) existed between anterior lumbar plexus displacement and evaluation with in vivo MRI at all levels between L1-L5 compared with cadaveric measurement. Supine position was also associated with significant (p < 0.001) anterior shift of the lumbar plexus at all levels between L1-L5. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis of the lumbar neural components and safe working zones for LLIF. Our analysis suggests that the lumbar plexus is significantly displaced ventrally with the supine compared to lateral decubitus position, and that MRI may overestimate ventral encroachment of lumbar plexus.
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Affiliation(s)
- Dallas E Kramer
- Department of Neurosurgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
| | - Cody Woodhouse
- Department of Neurosurgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Mena G Kerolus
- Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL, 60612, USA
| | - Alexander Yu
- Department of Neurosurgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA
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Buckland AJ, Ashayeri K, Leon C, Cheng I, Thomas JA, Braly B, Kwon B, Eisen L. Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches. 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 2022; 31:2175-2187. [PMID: 35235051 DOI: 10.1007/s00586-022-07127-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/22/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Circumferential (AP) lumbar fusion surgery is an effective treatment for degenerative and deformity conditions of the spine. The lateral decubitus position allows for simultaneous access to the anterior and posterior aspects of the spine, enabling instrumentation of both columns without the need for patient repositioning. This paper seeks to outline the anatomical and patient-related considerations in anterior column reconstruction of the lumbar spine from L1-S1 in the lateral decubitus position. METHODS We detail the anatomic considerations of the lateral ALIF, transpsoas, and anterior-to-psoas surgical approaches from surgeon experience and comprehensive literature review. RESULTS Single-position AP surgery allows simultaneous access to the anterior and posterior column and may combine ALIF, LLIF, and minimally invasive posterior instrumentation techniques from L1-S1 without patient repositioning. Careful history, physical examination, and imaging review optimize safety and efficacy of lateral ALIF or LLIF surgery. An excellent understanding of patient spinal and abdominal anatomy is necessary. Each approach has relative advantages and disadvantages according to the disc level, skeletal, vascular, and psoas anatomy. CONCLUSIONS A development of a framework to analyze these factors will result in improved patient outcomes and a reduction in complications for lateral ALIF, transpsoas, and anterior-to-psoas surgeries.
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Affiliation(s)
| | - Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, 462 1st Avenue, Suite 7S4, New York, NY, 10016, USA.
| | - Carlos Leon
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC, USA
| | - Brett Braly
- Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA
| | - Brian Kwon
- Division of Spine Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Leon Eisen
- NYU Langone Orthopedic Hospital, New York, NY, USA
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The Effect of Patient Position on Psoas Morphology and in Lumbar Lordosis. World Neurosurg 2021; 153:e131-e140. [PMID: 34166827 DOI: 10.1016/j.wneu.2021.06.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Among the interbody fusions, lateral lumbar interbody fusion allows access to the lumbar spine through the major psoas muscle, which offers several advantages to the spine surgeon. However, some of its drawbacks cause surgeons to avoid using it as a daily practice. Therefore, to address some of these challenges, we propose the prone transpsoas technique, differing mainly from the traditional technique on patient position-moving from lateral to prone decubitus, theoretically enhancing the lordosis and impacting the psoas morphology. METHODS Twenty-four consecutive patients were invited to have magnetic resonance imaging examinations in 3 different positions (prone, dorsal, lateral). Two observers measured the following parameters: vertebral body size, psoas diameter, psoas anterior border distance, plexus distance, total lumbar lordosis, distal lumbar lordosis, and proximal lumbar lordosis. Values of P < 0.05 were deemed significant. RESULTS The prone position yielded a significant increase in the lumbar lordosis, both in L1-S1 (57° vs. 46.5°) and proximal lordosis (40.4° vs. 36.9°) compared with the lateral position. Regarding the morphologic aspects, patients in the prone position presented lesser psoas muscles forward shift, but no difference was noted in the plexus position neither for L3-L4 nor L4-L5. CONCLUSIONS The prone position resulted in a significantly increased lumbar lordosis, both distal and proximal, which may enable the spine surgeon to achieve significant sagittal restoration just by positioning. The prone position also produced a posterior retraction of the psoas muscle. However, it did not significantly affect the position of the plexus concerning the vertebral body.
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Buckland AJ, Ashayeri K, Leon C, Manning J, Eisen L, Medley M, Protopsaltis TS, Thomas JA. Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine J 2021; 21:810-820. [PMID: 33197616 DOI: 10.1016/j.spinee.2020.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) with percutaneous posterior screw fixation are two techniques used to address degenerative lumbar pathologies. Traditionally, these anterior-posterior (AP) surgeries involve repositioning the patient from the supine or lateral decubitus position to prone for posterior fixation. To reduce operative time (OpTime) and subsequent complications of prolonged anesthesia, single-position lumbar surgery (SPLS) is a novel, minimally invasive alternative performed entirely from the lateral decubitus position. PURPOSE Assess the perioperative safety and efficacy of single position AP lumbar fusion surgery (SPLS). STUDY DESIGN Multicenter retrospective cohort study. PATIENT SAMPLE Three hundred and ninety patients undergoing AP surgery were included, of which 237 underwent SPLS and 153 were in the Flip group. OUTCOME MEASURES Outcome measures included levels fused, percentage of cases including L5-S1 fusion, fluoroscopy radiation dosage, OpTime, estimated blood loss (EBL), length of stay (LOS), and perioperative complications. Radiographic analysis included lumbar lordosis (LL), pelvic incidence, pelvic tilt, and segmental LL. METHODS Patients undergoing primary ALIF and/or LLIF surgery with bilateral percutaneous pedicle screw fixation between L2-S1 were included over a 4-year period. Patients were classified as either traditional repositioned "Flip" surgery or SPLS. Outcome measures included levels fused, percentage of cases including L5-S1 fusion, fluoroscopy radiation dosage, OpTime, EBL, LOS, perioperative complications. Radiographic analysis included LL, pelvic incidence, pelvic tilt, and segmental LL. All measures were compared using independent samples t-tests and chi-squared analyses as appropriate with significance set at p < .05. Propensity matching was completed where demographic differences were found. RESULTS Three hundred and ninety patients undergoing AP surgery were included, of which 237 underwent SPLS and 153 were in the Flip group. Age, gender, BMI, and CCI were similar between groups. Levels fused (1.47 SPLS vs 1.52 Flip, p = .468) and percent cases including L5-S1 (31% SPLS, 35% Flip, p = .405) were similar between cohorts. SPLS significantly reduced OpTime (103 min vs 306 min, p < .001), EBL (97 vs 313 mL, p < .001), LOS (1.71 vs 4.12 days, p < .001), and fluoroscopy radiation dosage (32 vs 88 mGy, p < .001) compared to Flip. Perioperative complications were similar between cohorts with the exception of postoperative ileus, which was significantly lower in the SPLS group (0% vs 5%, p < .001). There was no significant difference in wound, vascular injury, neurological complications, or Venous Thrombotic Event. There was no significant difference found in 90-day return to operating room (OR). CONCLUSIONS SPLS improves operative efficiency in addition to reducing blood loss, LOS and ileus in this large cohort study, while maintaining safety.
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Affiliation(s)
- Aaron J Buckland
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, New York, 530 1st Ave, Suite 8R, NY 10016, USA.
| | - Carlos Leon
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Jordan Manning
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Leon Eisen
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Mark Medley
- Atlantic Neurosurgical and Spine Specialists, Wilmington, 2208 S 17th St, NC 28401, USA
| | | | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, 2208 S 17th St, NC 28401, USA
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Lateral Lumbar Interbody Fusion at L4-5: A Morphometric Analysis of Psoas Anatomy and Cage Placement. World Neurosurg 2020; 141:e691-e699. [DOI: 10.1016/j.wneu.2020.05.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
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Kotheeranurak V, Singhatanadgige W, Ratanakornphan C, Yingsakmongkol W, Hynes RA, Limthongkul W. Neutral hip position for the oblique lumbar interbody fusion (OLIF) approach increases the retroperitoneal oblique corridor. BMC Musculoskelet Disord 2020; 21:583. [PMID: 32867737 PMCID: PMC7461341 DOI: 10.1186/s12891-020-03592-9] [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: 02/23/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prepsoas lateral approach for spinal fusion, oblique lateral lumbar interbody fusion (OLIF), is considered one of the minimally invasive spinal fusion methods and is gaining popularity due to improved outcomes with copious supporting evidence. To date, no publication has studied the various positions of the left hip in actual patients which might affect the retroperitoneal oblique corridor (ROC). The study aimed to find the relevancy of the left hip position and the size of ROC. METHODS We recruited 40 consecutive patients who needed diagnostic MRI from the out-patient clinic. MRI scan from L2 to L5 was performed in the supine, right lateral decubitus with hip flexion, and right lateral decubitus with hip in a neutral position. The retroperitoneal oblique corridor (ROC) was measured at the intervertebral disc level and compared. RESULTS ROC of the hip in neutral position was significantly larger than hip flexion in all levels (p < 0.05); there was no significant difference in the ROC among levels (p = 0.22). ROC seems to be largest at L2/3 followed by L3/4 and L4/5 respectively in all positions. CONCLUSIONS The retroperitoneal oblique corridors of L2 to L5 were significantly increased when the hip is in the neutral position, while the psoas cross-sectional area and anterior thickness were minimized in this position. Surgeons might benefit from a neutral position of the left hip in the oblique lateral lumbar interbody fusion (OLIF) procedure. In conclusion, the retroperitoneal oblique corridors of L2 to L5 were significantly increased when the hip is in the neutral position, while the psoas cross-sectional area and anterior thickness were minimized in this position. Surgeons might benefit from a neutral position of the left hip in the oblique lateral lumbar interbody fusion procedure.
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Sriracha, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand
| | | | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand
| | | | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
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Du L, Gao Y, Gao K, Yang G, Gao S. Lateral Position versus Prone Position for Cervical Laminoplasty: A Retrospective Comparative Study. Ther Clin Risk Manag 2020; 16:133-140. [PMID: 32110031 PMCID: PMC7041431 DOI: 10.2147/tcrm.s227799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the safety of lateral decubitus positions for cervical laminoplasty. Patients and Methods A retrospective comparative study was conducted on the safety between the lateral and prone positions in cervical laminoplasty. After screening, 466 patients who underwent cervical laminoplasty at a single medical center were enrolled and categorized into the lateral (n=229) and prone (n=237) groups. Data on positioning time, surgical time, blood loss, complication rates, and surgical outcomes were collected and compared between the two groups. The patients were further divided into underweight, normal weight, overweight, and obesity subgroups according to their body mass index, and the collected data were compared between the lateral and prone groups. Results The lateral group had a lower incidence of facial pressure ulcers (2.18%) than the prone group (11.39%). However, positioning time, surgical time, blood loss, and surgical outcomes were not significantly different between the two groups. In the subgroup analysis, no significant difference in positioning time, operative time, and blood loss was observed in the underweight, normal weight, and overweight patients between the two groups, but in the obesity subgroup, the lateral group had a significantly shorter positioning time (15.23±6.44 vs 21.63±9.43 min, P=0.045) and operative time (140.16±40.48 vs 178.62±51.82 min, P=0.037) and lesser blood loss (285.31±171.75 vs 430.46±189.84 mL, P=0.044) than the prone group. Conclusion The lateral position is as safe as the prone position for cervical laminoplasty, but it has advantages over the prone position for patients with obesity.
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Affiliation(s)
- Lin Du
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China.,Microbiome Laboratory, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yanzheng Gao
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Kun Gao
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Guang Yang
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Shanjun Gao
- Microbiome Laboratory, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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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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Eguchi Y, Norimoto M, Suzuki M, Haga R, Yamanaka H, Tamai H, Kobayashi T, Orita S, Suzuki M, Inage K, Kanamoto H, Abe K, Umimura T, Sato T, Aoki Y, Watanabe A, Koda M, Furuya T, Nakamura J, Akazawa T, Takahashi K, Ohtori S. Diffusion tensor tractography of the lumbar nerves before a direct lateral transpsoas approach to treat degenerative lumbar scoliosis. J Neurosurg Spine 2019; 30:461-469. [PMID: 30684934 DOI: 10.3171/2018.9.spine18834] [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: 07/09/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the relationship between vertebral bodies, psoas major morphology, and the course of lumbar nerve tracts using diffusion tensor imaging (DTI) before lateral interbody fusion (LIF) to treat spinal deformities. METHODS DTI findings in a group of 12 patients (all women, mean age 74.3 years) with degenerative lumbar scoliosis (DLS) were compared with those obtained in a matched control group of 10 patients (all women, mean age 69.8 years) with low-back pain but without scoliosis. A T2-weighted sagittal view was fused to tractography from L3 to L5 and separated into 6 zones (zone A, zones 1-4, and zone P) comprising equal quarters of the anteroposterior diameters, and anterior and posterior to the vertebral body, to determine the distribution of nerves at various intervertebral levels (L3-4, L4-5, and L5-S1). To determine psoas morphology, the authors examined images for a rising psoas sign at the level of L4-5, and the ratio of the anteroposterior diameter (AP) to the lateral diameter (lat), or AP/lat ratio, was calculated. They assessed the relationship between apical vertebrae, psoas major morphology, and the course of nerve tracts. RESULTS Although only 30% of patients in the control group showed a rising psoas sign, it was present in 100% of those in the DLS group. The psoas major was significantly extended on the concave side (AP/lat ratio: 2.1 concave side, 1.2 convex side). In 75% of patients in the DLS group, the apex of the curve was at L2 or higher (upper apex) and the psoas major was extended on the concave side. In the remaining 25%, the apex was at L3 or lower (lower apex) and the psoas major was extended on the convex side. Significant anterior shifts of lumbar nerves compared with controls were noted at each intervertebral level in patients with DLS. Nerves on the extended side of the psoas major were significantly shifted anteriorly. Nerve pathways on the convex side of the scoliotic curve were shifted posteriorly. CONCLUSIONS A significant anterior shift of lumbar nerves was noted at all intervertebral levels in patients with DLS in comparison with findings in controls. On the convex side, the nerves showed a posterior shift. In LIF, a convex approach is relatively safer than an approach from the concave side. Lumbar nerve course tracking with DTI is useful for assessing patients with DLS before LIF.
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Affiliation(s)
| | - Masaki Norimoto
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | | | - Ryota Haga
- 3Radiology, Shimoshizu National Hospital, Yotsukaido, Chiba
| | | | | | | | - Sumihisa Orita
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Miyako Suzuki
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Kazuhide Inage
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Hirohito Kanamoto
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Koki Abe
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Tomotaka Umimura
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Takashi Sato
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Yasuchika Aoki
- 4Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba
| | - Atsuya Watanabe
- 4Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba
| | - Masao Koda
- 5Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba City, Ibaraki; and
| | - Takeo Furuya
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Junichi Nakamura
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Tsutomu Akazawa
- 6Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazuhisa Takahashi
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Seiji Ohtori
- 2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba
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Ebata S, Ohba T, Haro H. New Intramuscular Electromyographic Monitoring with a Probe in Lateral Lumbar Interbody Fusion Surgery. Spine Surg Relat Res 2019; 3:106-111. [PMID: 31435562 PMCID: PMC6690128 DOI: 10.22603/ssrr.2018-0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The lateral lumbar interbody fusion (LLIF) surgical approach is minimally invasive and safely accesses the target region. Therefore, it is widely used in cases of lumbar spinal stenosis and spinal deformity. Intraoperative neuromonitoring is necessary to avoid nerve injury, whereas postoperative anterior thigh symptoms are not necessarily prevented. TECHNICAL NOTE In our institute, 85 LLIF operations have been performed. The first 30 cases were excluded from the present study to avoid surgical learning curve effects; conventional monitoring was used in 30 cases, whereas a new method with a probe to monitor intramuscular potential was used in 25 other cases. Anterior thigh symptoms and motor deficits were assessed postoperatively. The location of the electromyographic threshold decrease was at the posterior part of the disc at L2-3, but at the anterior part at L4-5. Compared with conventional monitoring, the new intramuscular monitoring significantly decreased the prevalence of motor deficits of the iliopsoas at 1 day and 30 days; anterior thigh pain at 1 day, 30, and 90 days; and anterior thigh numbness at 30 and 90 days postoperatively. CONCLUSIONS Compared with conventional monitoring, the new intramuscular monitoring with a less invasive probe may reduce anterior thigh symptoms.
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Affiliation(s)
- Shigeto Ebata
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
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Identification of abnormalities in the lumbar nerve tract using diffusion-weighted magnetic resonance neurography. 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; 28:849-854. [DOI: 10.1007/s00586-018-05867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023]
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Zeng ZY, Xu ZW, He DW, Zhao X, Ma WH, Ni WF, Song YX, Zhang JQ, Yu W, Fang XQ, Zhou ZJ, Xu NJ, Huang WJ, Hu ZC, Wu AL, Ji JF, Han JF, Fan SW, Zhao FD, Jin H, Pei F, Fan SY, Sui DX. Complications and Prevention Strategies of Oblique Lateral Interbody Fusion Technique. Orthop Surg 2018; 10:98-106. [PMID: 29878716 DOI: 10.1111/os.12380] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To analyze the early complications and causes of oblique lateral interbody fusion, and put forward preventive measures. METHODS There were 235 patients (79 males and 156 females) analyzed in our study from October 2014 to May 2017. The average age was 61.9 ± 0.21 years (from 32 to 83 years). Ninety-one cases were treated with oblique lateral interbody fusion (OLIF) alone (OLIF alone group) and 144 with OLIF combined with posterior pedicle screw fixation through the intermuscular space approach (OLIF combined group). In addition, 137/144 cases in the combined group were primarily treated by posterior pedicle screw fixation, while the treatments were postponed in 7 cases. There were 190 cases of single fusion segments, 11 of 2 segments, 21 of 3 segments, and 13 of 4 segments. Intraoperative and postoperative complications were observed. RESULTS Average follow-up time was 15.6 ± 7.5 months (ranged from 6 to 36 months). Five cases were lost to follow-up (2 cases from the OLIF alone group and 3 cases from the OLIF combined group). There were 7 cases of vascular injury, 22 cases of endplate damage, 2 cases of vertebral body fracture, 11 cases of nerve injury, 18 cases of cage sedimentation or cage transverse shifting, 3 cases of iliac crest pain, 1 case of right psoas major hematoma, 2 cases of incomplete ileus, 1 case of acute heart failure, 1 case of cerebral infarction, 3 case of left lower abdominal pain, 9 cases of transient psoas weakness, 3 cases of transient quadriceps weakness, and 8 cases of reoperation. The complication incidence was 32.34%. Thirty-three cases occurred in the OLIF alone group, with a rate of 36.26%, and 43 cases in the group of OLIF combined posterior pedicle screw fixation, with a rate of 29.86%. Fifty-seven cases occurred in single-segment fusion, with a rate of 30.0% (57/190), 4 cases occurred in two-segment fusion, with a rate of 36.36% (4/11), 9 cases occurred in three-segment fusion, with a rate of 42.86% (9/21), and 6 cases occurred in four-segment fusion, with a rate of 46.15% (6/13). CONCLUSION In summary, OLIF is a relatively safe and very effective technique for minimally invasive lumbar fusion. Nonetheless, it should be noted that OLIF carries the risk of complications, especially in the early stage of development.
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Affiliation(s)
- Zhong-You Zeng
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China.,Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Zhao-Wan Xu
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Deng-Wei He
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China.,Department of Spine, Lishui Center Hospital, Lishui, China
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Wei-Hu Ma
- Department of Spine, Ningbo Sixth Hospital, Ningbo, China
| | - Wen-Fei Ni
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong-Xing Song
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Jian-Qiao Zhang
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Wei Yu
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Xiang-Qian Fang
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Zhi-Jie Zhou
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Nan-Jian Xu
- Department of Spine, Ningbo Sixth Hospital, Ningbo, China
| | - Wen-Jian Huang
- Department of Spine, Lishui Center Hospital, Lishui, China
| | - Zhi-Chao Hu
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ai-Lian Wu
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian-Fei Ji
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Jian-Fu Han
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Hui Jin
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Fei Pei
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Shi-Yang Fan
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - De-Xiu Sui
- Orthopedics Medical Instruments of Hanwei, Weifang, China
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Orita S, Inage K, Furuya T, Koda M, Aoki Y, Kubota G, Nakamura J, Shiga Y, Matsuura Y, Maki S, Suzuki M, Hynes RA, Eguchi Y, Ohtori S. Oblique Lateral Interbody Fusion (OLIF): Indications and techniques. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.oto.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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