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Wu H, Cheung PWH, Soh RCC, Oh JYL, Cheung JPY. Equipoise for Lateral Access Surgery. World Neurosurg 2022; 166:e645-e655. [PMID: 35872127 DOI: 10.1016/j.wneu.2022.07.068] [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: 05/26/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the use of lateral access surgery among surgeons from the Asia-Pacific region to determine equipoise for areas of contentious use. METHODS A questionnaire was distributed to members of the Asia Pacific Spine Society. Surgeons were asked about their past experiences with lateral access surgery, including their advantages and disadvantages, specific surgical strategies, choices in implant-related factors, order of levels to operate on in multilevel reconstruction surgery, and postoperative complications. RESULTS A total of 69 of 102 surgeons (67.6%) had performed lateral access surgery previously. In total, 56 participating surgeons (54.9%) agreed that anterior column reconstruction via lateral access is most of time superior to transforaminal lumbar interbody fusion and other techniques. Surgeons would consider laminectomy instead of indirect decompression in the presence of severe central or lateral recess stenosis, thickened ligamentum flavum, and facet joint hypertrophy. For the order of levels to operate on in multiple level reconstruction for deformity, where 1 stands for L3-L4 or higher, 2 stands for L4-L5, and 3 stands for L5-S1, 2-1-3 (28/95, 29.5%) was most common, followed by 1-2-3 (26/95, 27.4%), and 3-2-1 (21/95, 22.1%). CONCLUSIONS Lateral access surgery is seeing greater use in the Asia-Pacific region, especially in upper middle- to high-income countries, whereas keenness of surgeons who practice in lower middle- to low-income countries can be improved by more training, resources, and reasonable cost. A high percentage of surgeons do not consider indirect decompression for spinal stenosis. There was no consensus on the order of levels in multiple level reconstruction for deformity.
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Affiliation(s)
- Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | | | | | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
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Hai Y, Liu J, Liu Y, Liu T, Zhang X, Pan A, Zhang Y, Ding H, Wu Y, Han B, Tang X. Expert Consensus on Clinical Application of Lateral Lumbar Interbody Fusion: Results From a Modified Delphi Study. Global Spine J 2021; 13:995-1004. [PMID: 34000874 DOI: 10.1177/21925682211012688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi study. OBJECTIVE The objective of this study was to establish expert consensus on the application of lateral lumbar interbody fusion (LLIF) by using the modified Delphi study. METHODS From June 2019 to March 2020, Members of the Chinese Study Group for Lateral Lumbar Spine Surgery were selected to collect expert feedback using the modified Delphi method where 65 spine surgeons from all over China agreed to participate. Four rounds were performed: 1 face-to-face meeting and 3 subsequent survey rounds. The consensus was achieved with ≥a 70.0% agreement for each question. The recommendation of grade A was defined as ≥90.0% of the agreement for each question. The recommendation of grade B was defined as 80.0-89.9% of the agreement for each question. The recommendation of grade C was defined as 70.0-79.9% of the agreement for each question. RESULTS A total of 65 experts formed a panelist group, and the number of questionnaires collected was 63, 59, and 62 in the 3 rounds. In total, 5 sections, 71 questions, and 382 items achieved consensus after the Delphi rounds including summary; preoperative evaluation; application at the lumbar spinal stenosis, lumbar disc herniation, lumbar spondylolisthesis, adult degenerative scoliosis, postoperative adjacent segmental degeneration, and revision surgery; complications; and postoperative follow-up evaluation of LLIF. CONCLUSION The modified Delphi method was utilized to ascertain an expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery to inform clinical decision-making in the application of LLIF. The salient grade A recommendations of the survey are enumerated.
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Affiliation(s)
- Yong Hai
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tie Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinuo Zhang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aixing Pan
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yiqi Zhang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuxuan Wu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bo Han
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinli Tang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Cui J, Guo X, Zheng Z, Liu H, Wang H, Li Z, Wang J. Perioperative Complications in 255 Patients Who Underwent Lateral Anterior Lumbar Interbody Fusion (LaLIF) Surgery. 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 2021; 30:2311-2322. [PMID: 33871706 DOI: 10.1007/s00586-021-06843-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the perioperative complications of lateral anterior lumbar interbody fusion (LaLIF) surgery. METHODS The participants were patients who underwent LaLIF surgery for degenerative lumbar diseases between April 2016 and November 2020. The collected data were classified into intraoperative and early-stage postoperative (1 month) complications. Intraoperative complications were subcategorized into nerve root injury, sympathetic chain injury, segmental artery injury, iliolumbar vein injury, peritoneum laceration, temporary psoas injury, endplate damage, and vertebral body fractures. Postoperative complications were subcategorized into surgical site infection, cage migration, cage subsidence and psoas major hematoma. RESULTS In the 255 included patients, 39 complications (15.3%) were reported. One patient (0.4%) had residual neurological symptoms (numbness) at the last follow-up after conservative management. The most common complications were temporary psoas injury (3.9%), followed by sympathetic chain injury (2.7%) and endplate damage (2.0%). The most frequent postoperative complication was cage migration (1.6%), followed by cage subsidence (1.2%), and surgical site infection (0.8%). CONCLUSION The complication rates for LaLIF are generally low and comparable to those for conventional OLIF and XLIF that have been reported in other studies. Almost all complications were transient after LaLIF. Severe complications can be avoided by using sufficient muscle relaxant, instruments with the required characteristics and vertical trajectories in multiple steps.
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Affiliation(s)
- Jiaming Cui
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China.,Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518000, China
| | - Xingyu Guo
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zhaomin Zheng
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China. .,Pain Research Center, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Hui Liu
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Hua Wang
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zemin Li
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jianru Wang
- Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan, 2nd Road, Guangzhou, 510080, Guangdong, China.
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Cui JM, Wang JR, Zheng ZM, Liu H, Wang H, Li ZM. Lateral-anterior lumbar interbody fusion (LaLIF) for lumbar degenerative disease: Technical notes, surgical system, and mid-term outcomes. J Orthop Translat 2021; 28:12-20. [PMID: 33575167 PMCID: PMC7859168 DOI: 10.1016/j.jot.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Many modified lateral lumbar interbody fusion techniques for lumbar degenerative diseases have been described by different authors. However, relatively high rates of vascular injury, peritoneal laceration, and even ureteral injury have been reported. Purpose The objectives of this study were firstly to present the detailed, standardized technical notes and describe the required standard characteristics of the designed surgical system of LaLIF and secondly to evaluate clinical outcomes and highlight the approach-related complications. Methods The mini-open LaLIF is described in a step-wise manner. The outcome measures were operative parameters, self-report measures, radiographic measures, and complications within 1 month of surgery. Operative parameters measured included operative time, intraoperative blood loss, and length of hospital stay. The self-report measures include Visual Analogue Scale (VAS), Oswestry disability index (ODI), and Short Form 36 Health Survey (SF-36) score. The radiographic measures including the intervertebral foraminal height (FH), intervertebral disc height (DH), and intervertebral foraminal area (FA) were assessed with plain radiography. The complication profiles were classified into intraoperative and postoperative (up to 1 month). Intraoperative complications were subcategorized into neurologic, vascular, ureteral, peritoneal, and vertebral injuries. Postoperative complications were subcategorized into infection, cage migration, and subsidence. Results A total of 126 patients who underwent LaLIF between April 2016 and December 2018 by a senior author were retrospectively reviewed. There were 54 males and 72 females (range 42–89 years old, average 65 ± 11 years old). The mean follow-up was 20 ± 11 months (range 6–38 months). The LaLIF was conducted at 188 levels in 126 patients, with 1 level in 75 cases, 2 levels in 42, 3 levels in 7, and 4 levels in 2 cases. There were 114 patients who underwent stand-alone LaLIF and 12 patients required secondary posterior fixation. The mean operative time, intraoperative blood loss, and length of hospital stay were recorded. The patient-reported outcome scores (VAS, ODI, and SF-36) and radiographic parameters (FH, DH, and FA) demonstrated a significant improvement after surgery and at the last follow-up. There were 25 (19.8%) complications in the 126 patients. The intraoperative complications accounted for 19 cases (15.1%) and postoperative accounted for 6 cases (4.8%). The most frequent complications were neurological injury (6.3%) and temporary psoas injury (6.3%). Conclusions The mini-open LaLIF, as a reproducible novel technique, can be performed safely at L2-L5. It is associated with reliable mid-term clinical outcomes and an acceptable complication profile when compared to traditional LLIF due to the advancements in the modified incision site, direct visualization, and usage of strictly vertical trajectory in multiple steps with the specially designed LaLIF system. Translational potential statement To make the lateral lumbar fusion process repeatable and also maintain a shallow learning curve, especially for surgeons in the early stages of learning, by using instruments with the required standard characteristics, the standardized surgical steps, modified incision site, vertical trajectory, and the direct visualization during the entire procedure.
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Affiliation(s)
- Jia-Ming Cui
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Jian-Ru Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Zhao-Min Zheng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Hua Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
| | - Ze-Min Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, 510080, Guangzhou, Guangdong, China
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