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Amaral R, Pokorny G, Alvernia JE, Pimenta L. L4-L5 anatomy classification system for lateral lumbar interbody fusion. Neurosurg Rev 2024; 47:529. [PMID: 39227486 DOI: 10.1007/s10143-024-02740-2] [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: 12/18/2023] [Revised: 06/18/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024]
Abstract
Lateral lumbar interbody fusion (LLIF), developed by Dr. Luiz Pimenta in 2006, allows access to the spinal column through the psoas major muscle. The technique has many advantages, such as reduced bone and muscular tissue damage, indirect decompression, larger implants, and lordosis correction capabilities. However, this technique also has drawbacks, with the most notorious being the risk of spinal pathologies due to indirect injury of the lumbar plexus, but with low rates of persistent injuries. Therefore, several groups have proposed classifications to help identify patients at a greater risk of presenting with neurological deficits. The present work proposes a classification system that relies on simple observation of easily identifiable key structures to guide lateral L4-L5 LLIF decision-making. Patients aged > 18 years who underwent preoperative magnetic resonance imaging (MRI) between 2022 and 2023 were included until 50 high-quality images were acquired. And excluded as follow Anatomical changes in the vertebral body or major psoas muscles prevent the identification of key structures or poor-quality MRIs. Each anatomy was classified as type I, type II, or type III according to the consensus among the three observers. Fifty anatomical sites were included in this study. 70% of the L4-L5 anatomy were type I, 18% were type II, and 12% were type III. None of the type 3 L4-L5 anatomies were approached using a lateral technique. The proposed classification is an easy and simple method for evaluating the feasibility of a lateral approach to-L4-L5.
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Affiliation(s)
- Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo , Brazil
| | | | | | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo , Brazil
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Zhao YB, Jin YZ, Zhao XF, Lu XD, Qi DT, Zhou RT, Wang XN, Liu HF, Chen L, Xi K, Yang-Zhang, Sun TS, Feng SQ, Zhang ZC, Zhao B. Clinical Analysis and Imaging Study of Lateral Lumbar Intervertebral Fusion in the Treatment of Degenerative Lumbar Scoliosis. Orthop Surg 2024. [PMID: 39077885 DOI: 10.1111/os.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure. METHODS A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results. RESULTS Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints. CONCLUSION Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.
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Affiliation(s)
- Yi-Bo Zhao
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Yuan-Zhang Jin
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Xiao-Feng Zhao
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Xiang-Dong Lu
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - De-Tai Qi
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Run-Tian Zhou
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Xiao-Nan Wang
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Hai-Feng Liu
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
| | - Liang Chen
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Kun Xi
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yang-Zhang
- Department of Orthopedic, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tian-Sheng Sun
- Department of Orthopedic, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shi-Qing Feng
- Department of Orthopaedics, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopaedics, Qilu Hospital of Shandong Universit, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong Universit, Jinan, Shandong, China
| | - Zhi-Cheng Zhang
- Department of Orthopedic, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bin Zhao
- Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China
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Buttermann G. Anterior Spinal Fusion for Thoraco-Lumbar Idiopathic Scoliosis Comparing Less Invasive Concave versus Traditional Convex Approach: A Pilot Study. J Clin Med 2024; 13:4383. [PMID: 39124650 PMCID: PMC11312509 DOI: 10.3390/jcm13154383] [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: 05/19/2024] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Anterior spinal fusion for primary thoracolumbar or lumbar (TL/L) adolescent idiopathic scoliosis, AIS, has advantages over posterior fusion, particularly in saving motion segments below the fusion construct. Traditionally, the approach is anterolaterally from the convexity. In adult degenerative scoliosis, the lateral or anterolateral approach may be performed from the traditional or from the concave approach which is less invasive and gives comparable outcomes. The purpose of the present pilot study was to assess the feasibility of the less invasive concave approach for younger AIS patients and compare it to the traditional convex approach over a 5-year follow-up period. Methods: The two cohorts were assessed by comparing pre- to postoperative radiographs, and clinical outcomes for pain, function, self-perception of appearance, and opinion of surgical success were prospectively obtained. Results: Radiographs found that primary TL/L scoliosis significantly improved from 53° to 18° (65%) for both the concave and convex cohorts. Sagittal alignments remained stable and there was no difference between cohorts. Coronal balance improved in both cohorts and sagittal balance was stable for both. Clinically, VAS back pain improved significantly for both cohorts initially and remained improved in the concave group. Leg pain, pain drawing, ODI disability, and VAS appearance scores improved and there was no difference between cohorts. The self-rating of success of the procedure was 100% at early and late follow-up periods. There were no neurological/surgical complications. Conclusions: The concave approach for anterior fusion for TL/L AIS is feasible with comparable radiographic and clinical outcomes to the traditional approach.
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Affiliation(s)
- Glenn Buttermann
- Midwest Spine & Brain Institute, 1950 Northwestern Avenue, Stillwater, MN 55082, USA
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Yamato Y, Hasegawa T, Yoshida G, Banno T, Oe S, Arima H, Ide K, Yamada T, Kurosu K, Nakai K, Matsuyama Y. Effect of Unintended Tissue Injury on the Development of Thigh Symptoms After Lateral Lumbar Interbody Fusion in Patients With Adult Spinal Deformity: A Retrospective Case Series. Spine (Phila Pa 1976) 2024; 49:181-187. [PMID: 37036284 DOI: 10.1097/brs.0000000000004663] [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: 04/11/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study aimed to investigate the effects of lateral lumbar interbody fusion (LLIF)-induced unintended tissue damage, including cage subsidence, cage malposition, and hematoma in the psoas major muscle, on the development of thigh symptoms. SUMMARY OF BACKGROUND DATA Thigh symptoms are the most frequent complications after LLIF and are assumed to be caused by lumbar plexus compression and/or direct injury to the psoas major muscle. However, the causes and risk factors of thigh symptoms are yet to be fully understood. MATERIALS AND METHODS Adult patients with spinal deformity who underwent two-stage surgery using LLIF and a posterior open fusion for the first and second stages, respectively, were included. Computed tomography and magnetic resonance imaging were routinely performed after LLIF before posterior surgery to investigate cage subsidence, cage malposition, and hematoma in the psoas muscle. We evaluated the development of thigh symptoms after LLIF and examined the effects of tissue injury on the occurrence of thigh symptoms. The differences in demographics and surgical and tissue damage parameters were compared between the groups with and without thigh symptoms using unpaired t tests and chi-squared tests. Factors associated with the development of thigh symptoms and muscle weakness were also assessed using logistic regression analysis. RESULTS Overall, 130 patients [17 men and 113 women; mean age, 68.7 (range, 47-84)] were included. Thigh symptoms were observed in 52 (40.0%) patients, including muscle weakness and contralateral side symptoms in 20 (15.4%) and 9 (17.3%) patients, respectively. The factors significantly associated with thigh symptoms identified after multiple logistic regression analysis included hematoma (odds ratio: 2.27, 95% CI, 1.03-5.01) and approach from the right side (odds ratio: 2.64, 95% CI, 1.21-5.75). The presence of cage malposition was the only significant factor associated with muscle weakness (odds ratio: 4.12, 95% CI, 1.37-12.4). CONCLUSIONS We found unintended tissue injury during LLIF was associated with thigh symptoms. We found that hematoma in the psoas major muscle and cage malposition were the factors associated with thigh symptoms and muscle weakness, respectively.
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Affiliation(s)
- Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Keiichi Nakai
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
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Lee JS, Son DW, Lee SH, Sung SK, Lee SW, Song GS, Kim YH, Choi CH. Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis. Medicine (Baltimore) 2022; 101:e31879. [PMID: 36482617 PMCID: PMC9726324 DOI: 10.1097/md.0000000000031879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55-79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.
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Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- * Correspondence: Dong Wuk Son, Department of Neurosurgery, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Korea (e-mail: )
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Saadeh YS, Strong MJ, Muhlestein WE, Yee TJ, Oppenlander ME. Commentary: Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E573-E575. [PMID: 34624888 DOI: 10.1093/ons/opab361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yamaan S Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Wewel JT, Ozpinar A, Walker CT, Okonkwo DO, Kanter AS, Uribe JS. Safety of lateral access to the concave side for adult spinal deformity. J Neurosurg Spine 2021; 35:100-104. [PMID: 33990079 DOI: 10.3171/2020.10.spine191270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) techniques, particularly lateral lumbar interbody fusion (LLIF), have become increasingly popular for adult spinal deformity (ASD) correction. Much discussion has been had regarding theoretical and clinical advantages to addressing coronal curvature from the convex versus concave side of the curve. In this study, the authors aimed to broadly evaluate the clinical outcomes of addressing ASD with circumferential MIS (cMIS) techniques while accessing the lumbar coronal curvature from the concave side. METHODS A multi-institution, retrospective chart and radiographic review was performed for all ASD patients with at least a 10° curvature, as defined by the Scoliosis Research Society, who underwent cMIS correction. The data collected included convex versus concave access to the coronal curve, durable or sensory femoral nerve injury lasting longer than 6 weeks, vascular injury, visceral injury, and any additional major complication, with at least a 2-year follow-up. Neither health-related quality-of-life metrics nor spinopelvic parameters were included within the scope of this study. RESULTS A total of 152 patients with ASD treated with cMIS correction via lateral access were identified and analyzed. Of these, 126 (82.9%) were approached from the concave side and 26 (17.1%) were approached from the convex side. In the concave group, 1 (0.8%) motor and 4 (3.2%) sensory deficit cases remained at 6 weeks after the operation. No vascular, visceral, or catastrophic intraoperative injuries were encountered in the concave group. Of the 26 patients in the convex group, 2 (7.7%) experienced motor deficits lasting longer than 6 weeks and 5 (19.2%) had lower-extremity sensory deficits. CONCLUSIONS It has been reported that lateral access to the convex side is associated with similar clinical and radiographic outcomes with fewer complications when compared with access to the concave side. Advantages to approaching the lumbar spine from the concave side include using one incision to access multiple levels, breaking the operative table to assist with curvature correction, easier access to the L4-5 disc space, the ability to release the contracted side, and, often, avoidance of the need to access or traverse the thoracic cavity. This study illustrates the largest reported cohort of concave access for cMIS scoliosis correction; few postoperative sensory and motor deficits were found.
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Affiliation(s)
- Joshua T Wewel
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Alp Ozpinar
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Corey T Walker
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - David O Okonkwo
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam S Kanter
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan S Uribe
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Lateral Lumbar Interbody Fusion: Review of Surgical Technique and Postoperative Multimodality Imaging Findings. AJR Am J Roentgenol 2020; 217:480-494. [PMID: 32903050 DOI: 10.2214/ajr.20.24074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The lateral lumbar interbody fusion (LLIF) approach is a minimally invasive surgery that can be used as an alternative to traditional lumbar interbody fusion techniques. LLIF accesses the intervertebral disk through the retroperitoneum and psoas muscle to avoid major vessels and visceral organs. The exposure of retroperitoneal structures during LLIF leads to unique complications compared with other surgical approaches. An understanding of the surgical technique and its associated potential complications is necessary for radiologists who interpret imaging before and after LLIF. Preoperative imaging must carefully assess the location of anatomic structures, including major retroperitoneal vasculature, lumbar nerve roots, lumbosacral plexus, and the genitofemoral nerve, relative to the psoas muscle. Multiple imaging modalities can be used in postoperative assessment including radiographs, CT, CT myelography, and MRI. Of these, CT is the preferred modality, because it can assess a range of complications relating to both the retroperitoneal exposure and the spinal instrumentation, as well as bone integrity and fusion status. This article describes surgical approaches for lumbar interbody fusion, comparing the approaches' indications, contraindications, advantages, and disadvantages; reviews the surgical technique of LLIF and relevant anatomic considerations; and illustrates for interpreting radiologists the normal postoperative findings and potential postsurgical complications of LLIF.
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Eun IS, Son SM, Goh TS, Lee JS. Sagittal spinopelvic alignment after spinal fusion in degenerative lumbar scoliosis: a meta-analysis. Br J Neurosurg 2020; 34:176-180. [DOI: 10.1080/02688697.2020.1725437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Il-Soo Eun
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Republic of Korea
| | - Seung Min Son
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Gudeok-Ro, Seo-Gu, Busan, Republic of Korea
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Weiss H, Garcia RM, Hopkins B, Shlobin N, Dahdaleh NS. A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion. Curr Rev Musculoskelet Med 2019; 12:328-339. [PMID: 31302861 PMCID: PMC6684700 DOI: 10.1007/s12178-019-09574-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature. RECENT FINDINGS Current literature demonstrates that minimally invasive surgery (MIS) in spine has improved clinical outcomes and reduced complications when compared with open spinal procedures. Recent studies describing MI-TLIF primarily for degenerative disk disease, spondylolisthesis, and vertebral canal stenosis cite over 89 discrete complications, with the most common being radiculitis (ranging from 2.8 to 57.1%), screw malposition (0.3-12.7%), and incidental durotomy (0.3-8.6%). Minimally invasive spine surgery has a distinct set of complications in comparison with other spinal procedures. These complications vary based on the exact MIS procedure and indication. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy.
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Affiliation(s)
- Hannah Weiss
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
| | - Roxanna M Garcia
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
- Institute for Public Health and Medicine (IPHAM), Center for Healthcare Studies, Northwestern University, Chicago, IL, USA
| | - Ben Hopkins
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
| | | | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA.
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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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Kanter AS, Tempel ZJ, Agarwal N, Hamilton DK, Zavatsky JM, Mundis GM, Tran S, Chou D, Park P, Uribe JS, Wang MY, Anand N, Eastlack R, Mummaneni PV, Okonkwo DO. Curve Laterality for Lateral Lumbar Interbody Fusion in Adult Scoliosis Surgery: The Concave Versus Convex Controversy. Neurosurgery 2018; 83:1219-1225. [PMID: 29361052 DOI: 10.1093/neuros/nyx612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive lateral lumbar interbody fusion (LLIF) is an effective adjunct in adult degenerative scoliosis (ADS) surgery. LLIF approaches performed from the concavity or convexity have inherent approach-related risks and benefits. OBJECTIVE To analyze LLIF approach-related complications and radiographic and clinical outcomes in patients with ADS. METHODS A multicenter retrospective review of a minimally invasive adult spinal deformity database was queried with a minimum of 2-yr follow-up. Patients were divided into 2 groups as determined by the side of the curve from which the LLIF was performed: concave or convex. RESULTS No differences between groups were noted in demographic, and preoperative or postoperative radiographic parameters (all P > .05). There were 8 total complications in the convex group (34.8%) and 21 complications in the concave group (52.5%; P = .17). A subgroup analysis was performed in 49 patients in whom L4-5 was in the primary curve and not in the fractional curve. In this subset of patients, there were 6 complications in the convex group (31.6%) compared to 19 in the concave group (63.3%; P < .05) and both groups experienced significant improvements in coronal Cobb angle, Oswestry Disability Index, and Visual Analog Scale score with no difference between groups. CONCLUSION Patients undergoing LLIF for ADS had no statistically significant clinical or operative complication rates regardless of a concave or convex approach to the curve. Clinical outcomes and coronal plane deformity improved regardless of approach side. However, in cases wherein L4-5 is in the primary curve, approaching the fractional curve at L4-5 from the concavity may be associated with a higher complication rate compared to a convex approach.
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Affiliation(s)
- Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Zachary J Tempel
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Gregory M Mundis
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Stacie Tran
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Paul Park
- Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Juan S Uribe
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | | | - Neel Anand
- Department of Neurological Surgery, Cedars-Sanai Medical Center, Los Angeles, California
| | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bae J, Lee SH. Minimally Invasive Spinal Surgery for Adult Spinal Deformity. Neurospine 2018; 15:18-24. [PMID: 29656622 PMCID: PMC5944633 DOI: 10.14245/ns.1836022.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this review is to present the current techniques and outcomes of adult spine deformity (ASD) surgery using the minimally invasive spine surgery (MISS) approach. We performed a systemic search of PubMed for literature published through January 2018 with the following terms: "minimally invasive spine surgery," "adult spinal deformity," and "degenerative scoliosis." Of the 138 items that were found through this search, 57 English-language articles were selected for full-text review. According to the severity of the deformity and the symptoms, various types of MISS have been utilized, such as MISS decompression, circumferential MISS, and hybrid surgery. With proper indications, the MISS approach achieved satisfactory clinical and radiological outcomes for ASD, with reduced complication rates. Future studies should aim to define clear indications for the application of various surgical options.
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Affiliation(s)
- Junseok Bae
- Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea
| | - Sang-Ho Lee
- Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, Korea
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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. 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 2018; 27:2272-2284. [DOI: 10.1007/s00586-018-5535-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Narain AS, Hijji FY, Markowitz JS, Kudaravalli KT, Yom KH, Singh K. Minimally invasive techniques for lumbar decompressions and fusions. Curr Rev Musculoskelet Med 2017; 10:559-566. [PMID: 29027622 DOI: 10.1007/s12178-017-9446-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to summarize the recent literature investigating the use of minimally invasive (MIS) techniques in the treatment of lumbar degenerative stenosis, spondylolisthesis, and scoliosis. RECENT FINDINGS MIS lumbar decompression and fusion techniques for degenerative pathology are associated with reduced operative morbidity, shortened length of hospital stay, and reduced postoperative pain and narcotics utilization. Recent studies with long-term clinical follow-up have demonstrated equivalence in clinical outcomes between open and MIS surgical procedures. Radiographically, MIS procedures provide adequate postoperative correction of coronal alignment. Correction of sagittal alignment, however, is more variable based on current reports. MIS techniques are both safe and effective in the treatment of lumbar degenerative pathologies. While some studies have reported on long-term outcomes and costs associated with MIS procedures, more investigation into these topics is still necessary. Additionally, further work is required to analyze the training requirements and learning curves of MIS procedures to better promote adoption amongst surgeons.
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Affiliation(s)
- Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Jonathan S Markowitz
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Krishna T Kudaravalli
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kelly H Yom
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Abstract
➢ Degenerative spinal deformity is common and affects a large percentage of the aging population. The burden of degenerative spinal deformity is high when measured on the basis of prevalence, impact, and cost of care.➢ A broad spectrum of specialists treat degenerative spinal deformities with use of both nonoperative and operative approaches to care. Treatment is characterized by substantial variability between and within specialties. Optimal care maximizes clinical benefit while limiting risks and costs.➢ This review describes the case of a 68-year-old woman with symptomatic degenerative scoliosis and presents perspectives on management from specialists in physical therapy, pain management, neurosurgery, and orthopaedic surgery.➢ The approaches to care presented here encompass a spectrum of risks, costs, and expected outcomes. Each specialist presents a perspective that is appropriate and reasonable, with its expected risks and benefits.➢ The best approach is one that is not monolithic; collaboration between providers from multiple disciplines permits an approach to care that is responsive to the values and preferences of the individual patient.➢ Clinical research, including prospective multidisciplinary comparative studies, is important for guiding an evidence-based approach to specific clinical scenarios and for developing a consensus regarding appropriate management strategies.
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