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Qin K, Tian H, Zhang K, Zhang K, Du L, Yan B, Huo Z, Deng M, Xu B. Exploration of the Extraperitoneal Approach for Single-Level Anterior Lumbar Interbody Fusion: Imaging, Anatomical and Clinical Research. Indian J Orthop 2023; 57:891-898. [PMID: 37214373 PMCID: PMC10192491 DOI: 10.1007/s43465-023-00869-8] [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: 06/28/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Background To explore extraperitoneal approach as an optimal option for reducing peritoneal disruption at a single-level disc in anterior lumbar interbody fusion (ALIF). Methods First, abdominal axial CT images obtained from 111 patients were observed to evaluate the distribution of extraperitoneal fat at L2-S1 and measure the lateral distances between the midline and the lateral borders of the rectus and the extraperitoneal fat for each disc level. Second, eight embalmed corpses were dissected along the lateral border of the rectus to expose the peritoneum, which was then separated laterally and medially to evaluate the distribution of fat and peritoneum adhesion. Finally, a total of 58 patients were selected for ALIF. For L2-L4 discs and L4-S1, the pararectus approach and the paramedian approach were utilized, respectively. Results Extraperitoneal fat was observed behind the rectus at the L5-S1 and the lateral distance between the fat and midline and the lateral border of the rectus gradually decreased on both sides of L2-5. On the cranial side of the arcuate line, it was easier to separate the peritoneum outward along the lateral edge of the rectus. When bluntly dissected medially, the peritoneum was closely adhered to abdominal wall. No complications such as peritoneal damage, retroperitoneal hematoma and neurological complications occurred in 58 patients undergoing the aforementioned surgical methods. Conclusions For L4-S1, the paramedian approach is the optimal technique to expose the disc, whereas the pararectus approach is the feasible surgical method at L2-4.
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Affiliation(s)
- Kexin Qin
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Heshun Tian
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Kunsheng Zhang
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Kaihui Zhang
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Lilong Du
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Bingshan Yan
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Zhenxin Huo
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Mingzhi Deng
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Baoshan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211 China
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Chen M, Peng DY, Hou WX, Li Y, Li JK, Zhang HX. Study of quality of life and its correlated factors in patients after lumbar fusion for lumbar degenerative disc disease. Front Surg 2023; 9:939591. [PMID: 36684249 PMCID: PMC9852631 DOI: 10.3389/fsurg.2022.939591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background In the present work, we aimed to explore the correlated factors of quality of life in patients receiving lumbar fusion for lumbar degenerative disc disease (DDD) in China. Methods A total of 180 patients treated with lumbar fusion were included in the present study. Their general demographic characteristics, Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, Simplified Coping Style Questionnaire (SCSQ), Social Support Questionnaire (SSQ), and Medical Outcomes Study Short Form 36 (MOS SF-36) were collected and evaluated preoperatively and at 1 year postoperatively. Results There were significant improvements in scores of VAS, JOA, and quality of life of patients from preoperation to 1-year postoperation after lumbar fusion. Marital status, with or without children, education level, economic pressure, and social support had significant predictive effects on the physical health of patients undergoing lumbar fusion. Marital status, education level, and economic pressure had significant predictive effects on the mental health of patients undergoing lumbar fusion. Conclusions Factors correlated with the physical health of patients after lumbar fusion included positive coping style, negative coping style, social support, age, education level (high school college), disease duration (5-10), suffering from other diseases (combined with two or more other disease) and the number of surgical segments (double and three or more). Factors correlated with the mental health included negative coping style, social support, age, education level (middle school and high school college) and the number of surgical segments (double and three or more). The results verify that these factors were correlated to the patient's quality of life after lumbar fusion. Emphasizing and selectively intervening these correlated factors can further improve the quality of life in patients receiving lumbar fusion for lumbar degenerative disc disease.
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Affiliation(s)
- Meng Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Da-Yong Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wen-Xiu Hou
- Department of Spine Surgery, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Yang Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jing-Kun Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hao-Xuan Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Lindado CA, Devia DA, Gutiérrez S, Patiño SI, Ocampo MI, Berbeo ME, Diaz RC. Intraoperative Complications of Anterior Lumbar Interbody Fusion: A 5-Year Experience of a Group of Spine Surgeons Performing Their Own Approaches. Int J Spine Surg 2022; 16:8299. [PMID: 35835569 PMCID: PMC9421205 DOI: 10.14444/8299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Spine surgery has evolved at an accelerated pace, allowing the development of more efficient surgical techniques while providing a decreasing rate of morbimortality. One example of these approaches is the anterior lumbar interbody fusion (ALIF). The aim of this study was to evaluate the surgical complication rate when performing ALIF without the help of a vascular "access" surgeon. METHODS A retrospective descriptive study was conducted at the Hospital Universitario San Ignacio between 2014 and 2018 and included all patients who underwent ALIF during this time. A nonsystematic review was performed assessing approach-related complications in ALIF and the impact of "access" surgeons in surgical outcomes. RESULTS A total of 337 patients were included and 508 levels were fused. ALIF was performed as ALIF-360° (27%), ALIF-lateral lumbar interbody fusion (LLIF) (8.9%), and stand-alone ALIF (62%). Most procedures were single-level fusions (51.9%), 45.4% involved 2 levels, and 2.6% were 3-level fusions. The mortality rate was 0%, and only 9 cases of vascular injury were observed and described. Left and common iliac veins were the predominant affected structures. Only a single case required blood transfusion without any other treatment or intensive care unit surveillance. CONCLUSIONS Our study is consistent with literature reports about ALIF complications, finding an incidence of 1.7%. Therefore, ALIF is an excellent alternative for spine procedures, especially for the levels L5-S1 that require sagittal balance restoration. The approaches were performed without a vascular "access" surgeon and presented complication rates similar to those described in the literature.
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Affiliation(s)
- Carlos Alberto Lindado
- Neurosurgery Department, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Diego Armando Devia
- Neurosurgery Department, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Santiago Gutiérrez
- Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Sergio Iván Patiño
- Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Maria Isabel Ocampo
- Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Miguel Enrique Berbeo
- Neurosurgery Department, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| | - Roberto Carlos Diaz
- Neurosurgery Department, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
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Pappa E, Evangelopoulos DS, Benetos IS, Pnevmaticos S. Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review. Cureus 2021; 13:e20267. [PMID: 35018263 PMCID: PMC8740846 DOI: 10.7759/cureus.20267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/08/2022] Open
Abstract
The incidence of anterior lumbar surgery is increasing as the population is aging. Although adverse events regarding vasculature injury are uncommon, several have been described in the current literature. Complications can be categorized based on the time of occurrence, more specifically intraoperative or postoperative, but also regarding the nature of vascular damage such as thrombosis, occlusion, or rupture. The rate of complications is higher in the setting of revision anterior surgery than with primary anterior lumbar surgery. Moreover, the incidence of revision anterior surgery is also increasing in contrast to the past. Through this narrative review, an effort is made for a thorough understanding of the complications associated with anterior lumbar surgery, which will aid in the prevention, recognition, and management of this rare complication.
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Is there a variance in complication types associated with ALIF approaches? A systematic review. Acta Neurochir (Wien) 2021; 163:2991-3004. [PMID: 34546435 PMCID: PMC8520518 DOI: 10.1007/s00701-021-05000-0] [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] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022]
Abstract
Purpose Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type. Methods A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach. Results A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05–0.21) and overall rates of complications (p = 0.05; CI = 0.00–0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = − 0.04–0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusion Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.
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Ahlquist S, Thommen R, Park HY, Sheppard W, James K, Lord E, Shamie AN, Park DY. Implications of sagittal alignment and complication profile with stand-alone anterior lumbar interbody fusion versus anterior posterior lumbar fusion. JOURNAL OF SPINE SURGERY 2020; 6:659-669. [PMID: 33447668 DOI: 10.21037/jss-20-595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Anterior lumbar interbody fusion (ALIF) is commonly utilized in lumbar degenerative pathologies. Standalone ALIF (ST-ALIF) systems were developed to avoid added morbidity, surgical time, and cost of anterior and posterior fusion (APF). Controversy exists in the literature about which of these two techniques yields superior clinical and radiographic outcomes, and few studies have directly compared them. This study seeks to compare ST-ALIF and APF in terms of sagittal correction and surgical complications. Methods Ninty-two consecutive ALIF cases performed from 2013-2018 were retrospectively reviewed and separated into 2 groups. Radiographic measurements were performed on pre- and post-operative radiographs, including segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL). Surgical complications were determined. Statistical analysis was performed using chi-square test of homogeneity, Fisher's exact test, and independent sample t-test. Comparisons between groups were deemed statistically significant at the P<0.05 threshold. Results Fifty-seven ST-ALIF, 35 APF were identified. There were no differences in age, gender, BMI, Charlson Comorbidity Index (CCI), preoperative diagnosis, or surgical level between the 2 cohorts. Bone Morphogenetic Protein (BMP) was utilized in 24.6% of ST-ALIF versus none of APF (P=0.001). No differences were detected in SL, LL, and PI-LL mismatch. ST-ALIF cohort had significantly greater risk of subsidence and revision surgery versus APF (12.3% vs. 0%, RD 95% CI: 3.8-20.8%, P=0.042). Recurrent spondylolisthesis occurred in 5 ST-ALIF cases, 3 cases with implant failure, and 2 nonunions versus none in the APF group. Conclusions ST-ALIF was associated with significantly greater subsidence and revision surgery versus APF. Careful patient selection is paramount when considering ST-ALIF. The potential for revision surgery may offset the potential benefit in avoiding posterior fusion. Despite the greater risk of subsidence, sagittal alignment was not significantly affected.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Rachel Thommen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - William Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Kevin James
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Elizabeth Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Arya N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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Shah M, Kolb B, Yilmaz E, Halalmeh DR, Moisi MD. Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature. Cureus 2019; 11:e5691. [PMID: 31720159 PMCID: PMC6823012 DOI: 10.7759/cureus.5691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many factors must be taken into account before choosing a surgical approach. In addition, the patient’s anatomy and pathology, lifestyle, and desires should be analyzed to help determine the ideal surgical strategy
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Affiliation(s)
- Manan Shah
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Bradley Kolb
- Neurosurgery, Rush University Medical Center, Chicago, USA
| | - Emre Yilmaz
- Surgery, Swedish Neuroscience Institute, Seattle, USA
| | | | - Marc D Moisi
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
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Sexual activity after spine surgery: a systematic review. 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; 27:2395-2426. [PMID: 29796731 DOI: 10.1007/s00586-018-5636-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/13/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Sexual function is an important determinant of quality of life, and factors such as surgical approach, performance of fusion, neurological function and residual pain can affect it after spine surgery. Our aim was to perform a systematic review to collate evidence regarding the impact of spine surgery on sexual function. METHODS A systematic review of studies reporting measures of sexual function, and incidence of adverse sexual outcomes (retrograde ejaculation) after major spine surgery was done, regardless of spinal location. Pubmed (MEDLINE) and Google Scholar databases were queried using the following search words "Sex", "Sex life", "Sexual function", "Sexual activity", "retrograde ejaculation", "Spine", "Spine surgery", "Lumbar surgery", "Lumbar fusion", "cervical spine", "cervical fusion", "Spinal deformity", "scoliosis" and "Decompression". All articles published between 1997 and 2017 were retrieved from the database. A total of 81 studies were included in the final review. RESULTS Majority of the studies were retrospective case series and were low quality (Level IV) in evidence. Anterior lumbar approaches were associated with a higher incidence of retrograde ejaculation, especially with the utilization of transperitoneal laparoscopic approach. There is inconclusive evidence on the preferred sexual position following fusion, and also on the impact of BMP-2 usage on retrograde ejaculation/sexual dysfunction. CONCLUSION Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery. Future studies incorporating specific assessments of sexual activity will be required to address this important determinant of quality of life so that appropriate pre-operative counselling can be done by providers. These slides can be retrieved under Electronic Supplementary Material.
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