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Issa TZ, Ezeonu T, Sellig M, Donnally CJ, Narayanan R, Karamian BA, Patel PD, Divi SN, Robinson WA, Shenoy K, Kepler CK, Vaccaro AR, Canseco JA. An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241279526. [PMID: 39197439 DOI: 10.1177/21925682241279526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2024] Open
Abstract
STUDY DESIGN Systematic Review and meta-analysis. OBJECTIVE To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons). METHODS A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model. RESULTS 54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall complication rate associated with anterior lumbar surgery was 13.1%, including an intraoperative complication rate of 3.8%, postoperative complication rate of 7.4%, infection rate of 1.5%, and reoperation rate of 1.7%. Forest plot analysis showed no significant difference in overall complication rates between open and mini-open techniques, although mini-open techniques were associated with lower overall reoperation rates. The use of CTA was associated with an increase in intraoperative and overall complications, and the use of an access surgeon was associated with a decreased risk of reoperation. The use of rhBMP-2 was not associated with overall complication risk. CONCLUSIONS While anterior lumbar surgery provides numerous benefits, surgeons and patients alike should be aware of the complication and safety profile prior to surgery. High quality studies are warranted to help elucidate the true benefit of certain techniques and adjuvant resources in reducing complications.
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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Mason Sellig
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Texas Spine Consultants, Addison, TX, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Kartik Shenoy
- Department of Orthopaedic Surgery, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
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Hiyama A, Katoh H, Sakai D, Sato M, Watanabe M. Short-Term Comparison Between Unilateral Versus Bilateral Percutaneous Pedicle Screw Fixation in Short-Level Lateral Lumbar Interbody Fusion-A Prospective Randomized Study. Global Spine J 2024; 14:1485-1497. [PMID: 36585946 PMCID: PMC11394500 DOI: 10.1177/21925682221146500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN Prospective randomized controlled trial. OBJECTIVES No prospective studies have directly compared clinical and radiographic outcomes of unilateral vs bilateral instrumented lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease (LDD). We compared the short-term radiographic, clinical outcomes, and some complications of the unilateral percutaneous pedicle screw (PPS) (UPS) vs bilateral PPS (BPS) fixation in short-level spinal fusion with LLIF for LDD. METHODS This was a prospective randomized controlled study of 33 patients who underwent UPS or BPS fixation after LLIF for LDD; 18 patients were assigned to the UPS group and 15 patients to the BPS group. Clinical outcomes, complication rates, and fusion rates were assessed. RESULTS The two groups were similar in age, sex, preoperative diagnosis, and level of surgery. Blood loss, length of hospital stay, and numeric rating scale score one year after surgery did not differ between groups. The operative time was longer in the BPS than UPS group (120.2 vs 88.8 min, respectively; P = .029). Both groups showed improvement in disc height and dural sac in the immediate postoperative computed tomography and magnetic resonance imaging, which did not differ significantly between groups. The subsidence grade and fusion rate did not differ, but cage subsidence was more severe in the UPS than BPS group. CONCLUSION Unilateral and bilateral PPS fixation after LLIF yielded similar short-term clinical and radiological outcomes. However, severe cage subsidence was more common in the UPS group, which suggests that BPS fixation after LLIF may be a better choice over the long term.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
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Drossopoulos PN, Bardeesi A, Wang TY, Huang CC, Ononogbu-uche FC, Than KD, Crutcher C, Pokorny G, Shaffrey CI, Pollina J, Taylor W, Bhowmick DA, Pimenta L, Abd-El-Barr MM. Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases. J Clin Med 2024; 13:1112. [PMID: 38398424 PMCID: PMC10889296 DOI: 10.3390/jcm13041112] [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: 12/19/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The Prone Transpsoas (PTP) approach to lumbar spine surgery, emerging as an evolution of lateral lumbar interbody fusion (LLIF), offers significant advantages over traditional methods. PTP has demonstrated increased lumbar lordosis gains compared to LLIF, owing to the natural increase in lordosis afforded by prone positioning. Additionally, the prone position offers anatomical advantages, with shifts in the psoas muscle and lumbar plexus, reducing the likelihood of postoperative femoral plexopathy and moving critical peritoneal contents away from the approach. Furthermore, operative efficiency is a notable benefit of PTP. By eliminating the need for intraoperative position changes, PTP reduces surgical time, which in turn decreases the risk of complications and operative costs. Finally, its versatility extends to various lumbar pathologies, including degeneration, adjacent segment disease, and deformities. The growing body of evidence indicates that PTP is at least as safe as traditional approaches, with a potentially better complication profile. In this narrative review, we review the historical evolution of lateral interbody fusion, culminating in the prone transpsoas approach. We also describe several adjuncts of PTP, including robotics and radiation-reduction methods. Finally, we illustrate the versatility of PTP and its uses, ranging from 'simple' degenerative cases to complex deformity surgeries.
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Affiliation(s)
- Peter N. Drossopoulos
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Anas Bardeesi
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Timothy Y. Wang
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Favour C. Ononogbu-uche
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Khoi D. Than
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Clifford Crutcher
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Gabriel Pokorny
- Institute of Spinal Pathology, Sao Paulo 04101000, SP, Brazil; (G.P.)
| | - Christopher I. Shaffrey
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - William Taylor
- Department of Neurological Surgery, University of California, La Jolla, San Diego, CA 92093, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
| | - Luiz Pimenta
- Institute of Spinal Pathology, Sao Paulo 04101000, SP, Brazil; (G.P.)
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA (K.D.T.)
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Brown NJ, Pennington Z, Kuo CC, Lopez AM, Picton B, Solomon S, Nguyen OT, Yang C, Tantry EK, Shahin H, Gendreau J, Albano S, Pham MH, Oh MY. Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis. Asian Spine J 2023; 17:1139-1154. [PMID: 38105638 PMCID: PMC10764124 DOI: 10.31616/asj.2023.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 12/19/2023] Open
Abstract
Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: "(laparoscopic OR endoscopic) AND (anterior AND lumbar)." Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio's "metafor" package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.
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Affiliation(s)
- Nolan J. Brown
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN,
USA
| | - Cathleen C. Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, NY,
USA
| | - Alexander M. Lopez
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Bryce Picton
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Sean Solomon
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Oanh T. Nguyen
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Chenyi Yang
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | | | - Hania Shahin
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD,
USA
| | - Stephen Albano
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Martin H. Pham
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA,
USA
| | - Michael Y. Oh
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
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Lovecchio F, Shahi P, Patel A, Qureshi S. Single-position Minimally Invasive Surgery for Correction of Adult Spinal Deformity. J Am Acad Orthop Surg 2023; 31:e590-e600. [PMID: 37162446 DOI: 10.5435/jaaos-d-22-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023] Open
Abstract
Minimally invasive adult spinal deformity (MIS ASD) surgery may offer benefits over conventional techniques in select circumstances. The success of the procedure is based on proper patient selection, restoring adequate alignment, and optimizing fusion. In the past, MIS techniques were limited because of the need to reposition the patient-a source of increased surgical time and potentially patient risk. New developments now allow for single-position, MIS correction of adult deformity. Additional research will be needed to determine the ideal patient for minimally invasive adult spinal deformity surgery and whether prone or lateral single-position confers the best outcomes.
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Affiliation(s)
- Francis Lovecchio
- From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Lovecchio, Shahi, and Qureshi) and the Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL (Patel)
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Zhou T, Gu Y. Percutaneous transforaminal endoscopic surgery (PTES) and mini-incision L5/S1 OLIF with a self-lock cage for the surgical treatment of L5 spondylolisthesis. J Orthop Surg Res 2023; 18:527. [PMID: 37488544 PMCID: PMC10367385 DOI: 10.1186/s13018-023-04022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES We reported thirteen cases of percutaneous transforaminal endoscopic surgery (PTES) under local anesthesia and mini-incision L5/S1 OLIF (OLIF51) with a self-lock cage for the treatment of L5 spondylolisthesis. METHODS From Jan 2019 to Feb 2020, the patients with L5 spondylolisthesis with nerve root symptoms undergoing PTES and OLIF51 were included in this study. PTES under local anesthesia was performed in a prone position, and OLIF51 with a self-lock cage and allograft was then undertaken through a left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using the VAS, and the clinical outcomes were evaluated with the ODI before surgery and at the 2-year follow-up. The anterior and posterior intervertebral space height (AISH, PISH), lumbar lordotic, and surgical segmental lordotic angle (SLA) were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to Bridwell's fusion grades. RESULTS Thirteen cases of L5 spondylolisthesis were included. The operation duration was 49.1 ± 5.6 min for PTES and 73.6 ± 8.2 min for OLIF. There was blood loss of 25 (15-45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5 (4-6) days, and the follow-up duration was 29 (24-37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001), and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). AISH, PISH and SLA significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 9 segments (69.2%) and grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage or major complications. No failure of instruments was observed. CONCLUSIONS PTES and mini-incision OLIF51 with a self-lock cage is a viable option of minimally invasive surgery for L5 spondylolisthesis, which can achieve direct neurologic decompression, satisfactory fusion and hardly destroys the rectus abdominis and its sheath, paraspinal muscles and bone structures.
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Affiliation(s)
- Tianyao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Yutong Gu
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
- Shanghai Southwest Spine Surgery Center, Shanghai, China.
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Gong K, Zhu Z, Wei J, Li F, Xiong W. The anatomical feasibility of anterior intra- and extra-bifurcation approaches to L5-S1: an anatomic study based on lumbar MRI. Spine J 2023; 23:1068-1078. [PMID: 36822511 DOI: 10.1016/j.spinee.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND CONTEXT The anterior approach at L5-S1 has many advantages, however, vascular complications are challenging for spinal surgeons who may not be familiar with the variability of vascular anatomy. There are three different anterior approaches (intra-bifurcation approach and extra-bifurcation: left-, and right-sided prepsoas approaches) described in previous studies to respond to the variability of anterior vascular anatomy for reduction in vascular injury, while no guidance for the choice of approach preoperatively. PURPOSE To analyze the anatomical feasibility of three anterior approaches to access the L5-S1 disc space according to a practical framework. STUDY DESIGN Retrospective study. PATIENT SAMPLE Lumbar magnetic resonance imaging (MRI) from patients who visited our outpatient clinic were reviewed, with 150 cases meeting the inclusion criteria. OUTCOME MEASURES The following radiographic parameters were measured on axial T2-weighted MRI at the lower endplate of L5 and the upper endplate of S1: width of the vascular corridor, position of the left and right common iliac vein (CIV), and presence of perivascular adipose tissue (PAT). Moreover, we designed a safe line to evaluate the feasibility of left- and right-sided prepsoas approaches. Cases of lumbosacral transitional vertebrae were identified. METHODS The feasibility of the intra-bifurcation approach was determined by the width of the vascular corridor, presence of PAT, and the position of the CIV. The feasibility of the prepsoas approach was determined by the relative position of the CIV to the safe line, presence of PAT, and the intersection point of the CIV and vertebral body. RESULTS Sixty-eight percent, 64.7%, and 75.3% cases allowed the intra-bifurcation, left-, and right-sided prepsoas approach to L5-S1, respectively. The cases in this study had at least one of three anterior approaches to access L5-S1 disc space, and 74% of cases had more than one anatomical feasibility of anterior approach. The right-sided prepsoas approach was feasible in the majority of cases because of the vertical course of the right CIV with a significantly higher proportion of presence of PAT. Patients with lumbosacral transitional vertebrae (24 cases) may prefer the prepsoas approaches, and only six cases (25.0%) were determined to be feasible for the intra-bifurcation approach. CONCLUSIONS Our study proposes a practical framework to determine whether the three different anterior approaches are feasible access at L5-S1. According to the framework, all cases had the anatomical feasibility of using an anterior approach to access L5-S1, and three-fourths of cases had a replaceable anterior approach when encountering intraoperative difficulties.
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Affiliation(s)
- Ke Gong
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Ziwei Zhu
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Jiemao Wei
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China
| | - Wei Xiong
- Department of Orthopedics, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Ave, Wuhan, China.
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Turlip R, Ahmad HS, Ghenbot YG, Wathen C, Chauhan D, McCloskey K, Yoon JW. Characterizing and Improving Nomenclature for Reporting Lumbar Interbody Fusion Techniques. World Neurosurg 2023; 175:e134-e140. [PMID: 36921714 DOI: 10.1016/j.wneu.2023.03.040] [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: 11/20/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. This study systematically analyzes LIF nomenclature in contemporary literature and proposes a standardized classification system for reporting LIF terminology. METHODS A search query was conducted through the PubMed database using "lumbar fusion OR lumbar interbody fusion." A total of 1455 articles were identified, and 605 references to LIF were recorded. Following a systematic review of the terminology, we developed a LIF reporting guidelines that capture the existing LIF nomenclature while avoiding redundant or ambiguous terminology. RESULTS The most referenced anatomical approaches were transforaminal (43.0%), followed by posterior (25.0%), lateral (19.7%), and anterior (10.9%). Overall, there were 72 unique ways to describe LIF. Unique prefixes were recorded by approach (posterior: 26; lateral: 13; anterior: 3). Forty unique prefixes/suffixes overlapped in their usage. "MI" (14.4%), "MIS" (38.1%), and "MISS" (0.6%) all referenced a minimally invasive approach. "O" (12.5%), "CO" (1.3%), and "TO" (1.3%) all described open techniques. "Endo" (0.6%), "Endoscopic-assisted" (1.3%), and "PE" (1.9%) all referenced endoscopic-assisted procedures. CONCLUSIONS The current LIF nomenclature contains many unique LIF terms that were found to be inconsistently defined, redundant, or ambiguous. We propose the standardization of a 4-part naming system which highlights the crucial parts of LIF: (1) intraoperative repositioning, (2) patient position, (3) anatomical approach, and (4) orientation of the surgical corridor to the psoas muscles.
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Affiliation(s)
- Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes G Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Ghenbot Y, Ahmad HS, Chauhan D, McCloskey K, Turlip R, Yoon JW. Simultaneous Anterior Posterior Approach for Single-Position Lateral Lumbar Interbody Fusion with Robotic Assistance: Technical Guidelines and Early Outcomes. World Neurosurg 2023; 170:e425-e430. [PMID: 36396051 DOI: 10.1016/j.wneu.2022.11.038] [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: 08/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbar lateral interbody fusion (LLIF) is traditionally performed in 2 stages: placing the interbody cage in the lateral decubitus position, then placing the percutaneous pedicle screw in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes associated with longer operative times. We describe the operative steps and report clinical and radiographic outcomes associated with a simultaneous anterior and posterior approach (SAPA) for LLIF. METHODS Patients who underwent SAPA LLIF performed by a single surgeon over 1 year were retrospectively reviewed. Demographic, clinical, and radiographic data were analyzed, an operative guideline was created, and a learning curve was constructed using operative times. RESULTS SAPA LLIF was performed in 11 patients. Three patients experienced transient postoperative femoral nerve plexopathy with symptoms of ipsilateral hip flexion weakness and/or anterior thigh numbness; there were no other complications in the cohort. Radiographically, patients achieved significant increases in disc height (8.3 mm vs. 13.5 mm, P = 0.002) and foraminal height (20.2 mm vs. 25.3 mm, P = 0.0001). Patients showed significant improvements in Oswestry Disability Index (52 vs. 27.8, P = 0.002) and Patient-Reported Outcome Measurement Information System Physical Function (32.6 vs. 39, P = 0.048) and Pain Interference (64.9 vs. 59.6, P = 0.001) at 3 months. A downward trend in operative time was observed for 1-level SAPA LLIF. CONCLUSIONS SAPA LLIF is a safe approach for LLIF that results in favorable clinical outcomes. This technique can potentially improve operative efficiency further along the course of a surgeon's learning curve.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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The Prone Lateral Approach for Lumbar Fusion-A Review of the Literature and Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020251. [PMID: 36837453 PMCID: PMC9967790 DOI: 10.3390/medicina59020251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Lateral lumbar interbody fusion is an evolving procedure in spine surgery allowing for the placement of large interbody devices to achieve indirect decompression of segmental stenosis, deformity correction and high fusion rates through a minimally invasive approach. Traditionally, this technique has been performed in the lateral decubitus position. Many surgeons have adopted simultaneous posterior instrumentation in the lateral position to avoid patient repositioning; however, this technique presents several challenges and limitations. Recently, lateral interbody fusion in the prone position has been gaining in popularity due to the surgeon's ability to perform simultaneous posterior instrumentation as well as decompression procedures and corrective osteotomies. Furthermore, the prone position allows improved correction of sagittal plane imbalance due to increased lumbar lordosis when prone on most operative tables used for spinal surgery. In this paper, we describe the evolution of the prone lateral approach for interbody fusion and present our experience with this technique. Case examples are included for illustration.
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Buckland AJ, Braly BA, O'Malley NA, Ashayeri K, Protopsaltis TS, Kwon B, Cheng I, Thomas JA. Lateral decubitus single position anterior posterior surgery improves operative efficiency, improves perioperative outcomes, and maintains radiological outcomes comparable with traditional anterior posterior fusion at minimum 2-year follow-up. Spine J 2023; 23:685-694. [PMID: 36641035 DOI: 10.1016/j.spinee.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND CONTEXT The advantages of Lateral Single Position surgery (LSPS) in the perioperative period has previously been demonstrated, however 2-year postoperative outcomes of this novel technique have not yet been compared to circumferential anterior-posterior fusion (FLIP) at 2-years postoperatively. PURPOSE Evaluate the safety and efficacy of LSPS versus gold-standard FLIP STUDY DESIGN/SETTING: Multi-center retrospective cohort review. PATIENT SAMPLE Four hundred forty- two patients undergoing lumbar fusion via LSPS or FLIP OUTCOME MEASURES: Levels fused, operative time, estimated blood loss, perioperative complications, and reasons for reoperation at 30-days, 90-days, 1-year, and 2-years. Radiographic outcomes included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch, and segmental lumbar lordosis. METHODS Patients were grouped as LSPS if anterior and posterior portions of the procedure were performed in the lateral decubitus position, and FLIP if patients were repositioned from supine or lateral to prone position for the posterior portion of the procedure under the same anesthetic. Groups were compared in terms of demographics, intraoperative, perioperative and radiological outcomes, complications and reoperations up to 2-years follow-up. Measures were compared using independent samples or paired t-tests and chi-squared analyses with significance set at p<.05. RESULTS Four hundred forty- two pts met inclusion, including 352 LSPS and 90 FLIP pts. Significant differences were noted in age (62.4 vs 56.9; p≤.001) and smoking status (7% vs 16%; p=.023) between the LSPS and FLIP groups. LSPS demonstrated significantly lower Op time (97.7min vs 297.0 min; p<.001), fluoro dose (36.5mGy vs 78.8mGy; p<.001), EBL (88.8mL vs 270.0mL; p<.001), and LOS (1.91 days vs 3.61 days; p<.001) compared to FLIP. LSPS also demonstrated significantly fewer post-op complications than FLIP (21.9%vs 34.4%; p=.013), specifically regarding rates of ileus (0.0% vs 5.6%; p<.001). No differences in reoperation were noted at 30-day (1.7%LSPS vs 4.4%FLIP, p=.125), 90-day (5.1%LSPS vs 5.6%FLIP, p=.795) or 2-year follow-up (9.7%LSPS vs 12.2% FLIP; p=.441). LSPS group had a significantly lower preoperative PI-LL (4.1° LSPS vs 8.6°FLIP, p=.018), and a significantly greater postoperative LL (56.6° vs 51.8°, p = .006). No significant differences were noted in rates of fusion (94.3% LSPS vs 97.8% FLIP; p=.266) or subsidence (6.9% LSPS vs 12.2% FLIP; p=.260). CONCLUSIONS LSPS and circumferential fusions have similar outcomes at 2-years post-operatively, while reducing perioperative complications, improving perioperative efficiency and safety.
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Affiliation(s)
- Aaron J Buckland
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia; Spine and Scoliosis Research Associates Australia, Melbourne, VIC, Australia; Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| | | | - Nicholas A O'Malley
- Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kimberly Ashayeri
- Spine Research Center, Departments of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA; Department of Neurosurgery, NYU Langone Health, New York, NY, USA
| | | | - Brian Kwon
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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Menezes CM, Alamin T, Amaral R, Carvalho AD, Diaz R, Guiroy A, Lam KS, Lamartina C, Perez-Contreras A, Rivera-Colon Y, Smith W, Taboada N, Timothy J, Langella F, Berjano P. Need of vascular surgeon and comparison of value for anterior lumbar interbody fusion (ALIF) in lateral decubitus: Delphi consensus. 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; 31:2270-2278. [PMID: 35867159 DOI: 10.1007/s00586-022-07319-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF). METHODS A two-round Delphi method study was conducted to assess the consensus, within expert spine surgeons, regarding the perception of safety, the preoperative planning, the complications management and the need for vascular surgeons by performing anterior approaches (SupALIF vs LatALIF). RESULTS A total of 14 experts voluntary were involved in the survey. From 82 sentences voted in the first round, a consensus was reached for 38 items. This included the feasibility of safe LatALIF without systematic involvement of vascular surgeon for routine cases (while for revision cases the involvement of the vascular surgeon is an appropriate option) and the appropriateness of standard MRI to evaluate the accessibility of the vascular window. Thirteen sentences reached the final consensus in the second round, whereas no consensus was reached for the remaining 20 statements. CONCLUSIONS The Delphi study collected the consensus on several points, such as the consolidated required experience on anterior approaches, the accurate study of vascular anatomy with MRI, the management of complications and the significant reduction of the surgical times of the LatALIF if compared to SupALIF in combined procedures. Furthermore, the study group agrees that LatALIF can be performed without the need for a vascular surgeon in routine cases.
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Affiliation(s)
| | - Todd Alamin
- Department of Orthopedic Surgery and Neurosurgery, Stanford University Medical Center, Redwood City, CA, USA
| | - Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, Brazil
| | | | - Roberto Diaz
- Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogotá, D.C, Colombia
| | - Alfredo Guiroy
- Elite Spine Health and Wellness Center, Fort Lauderdale, Florida, USA
| | | | | | - Alberto Perez-Contreras
- Director de Líderes en Cerebroy, Columna del Hospital Angeles del Pedregal, Ciudad de Mexico, Mexico
| | | | - Willian Smith
- University Medical Center of Southern Nevada, Las Vegas, NV, USA
| | - Nestor Taboada
- Department of Neurosurgery, Clínica Portoazul, Barranquila, Colombia
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Keorochana G, Muljadi JA, Kongtharvonskul J. Perioperative and Radiographic Outcomes Between Single-Position Surgery (Lateral Decubitus) and Dual-Position Surgery for Lateral Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation: Meta-Analysis. World Neurosurg 2022; 165:e282-e291. [PMID: 35710097 DOI: 10.1016/j.wneu.2022.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Lateral lumbar interbody fusion (LLIF) and percutaneous posterior screw fixation (PPSF) techniques is used to treat degenerative lumbar pathologies. Dual-position (DP) lumbar surgery involves repositioning the patient from the supine or lateral decubitus position to prone for posterior fixation. Single-position (SP) lumbar surgery is commonly performed nowadays, a minimally invasive alternative performed entirely from the lateral decubitus position. However, controversy still exists. This meta-analysis aimed to compare perioperative outcomes between SP lumbar surgery and DP lumbar surgery for LLIF and PPSF. METHODS We conducted this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched Medline and Scopus from inception to November 11, 2021, for relevant studies. RESULTS Six studies were identified, which contained totals of 502 and 447 patients in the SP and DP groups, respectively. The unstandardized mean difference in operative time, length of hospital stay, intraoperative blood loss, radiation doses, lumbar lordosis, and pelvic incidence-lumbar lordosis mismatch were -86.1 (95% confidence interval [CI] -149.2 to -23.1) minutes, -1.6 (95% CI -2.4 to -0.9) days, -55.6 (95% CI -127.5 to 16.2) mL, -30.3 (95% CI -80.5 to 19.8) mGy, 1.34 (95% CI -1.17 to 3.86) degrees, and -4.06 (95% CI -5.65 to -2.47) lower in SP when compared with DP. The chances of having complications and reoperations in SP were 0.75 (95% CI 0.49-1.14) and 0.77 (95% CI 0.44-1.36) times, respectively, compared with the DP group. No significant differences were found for intraoperative blood loss, radiation dose, lumbar lordosis, complications, and reoperations between the 2 groups. CONCLUSIONS This meta-analysis found that SP have lower operative time and length of hospital stay compared with DP LLIF and PPSF. However, no differences in intraoperative blood loss, radiation dose, radiographic change, complications, and reoperation rates were found.
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Affiliation(s)
- Gun Keorochana
- Orthopedics Department, Bangkok, Thailand; Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand; Mahidol University, Bangkok, Thailand
| | | | - Jatupon Kongtharvonskul
- Section for Clinical Epidemiology and Biostatistics, Bangkok, Thailand; Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
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Haider G, Wagner KE, Chandra V, Cheng I, Stienen MN, Veeravagu A. Utilization of lateral anterior lumbar interbody fusion for revision of failed prior TLIF: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2296. [PMID: 35733821 PMCID: PMC9204934 DOI: 10.3171/case2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of the lateral decubitus approach for L5–S1 anterior lumbar interbody fusion (LALIF) is a recent advancement capable of facilitating single-position surgery, revision operations, and anterior column reconstruction. To the authors’ knowledge, this is the first description of the use of LALIF at L5–S1 for failed prior transforaminal lumbar interbody fusion (TLIF) and anterior column reconstruction. Using an illustrative case, the authors discuss their experience using LALIF at L5–S1 for the revision of pseudoarthrosis and TLIF failure. OBSERVATIONS The patient had prior attempted L2 to S1 fusion with TLIF but suffered from hardware failure and pseudoarthrosis at the L5–S1 level. LALIF was used to facilitate same-position revision at L5–S1 in addition to further anterior column revision and reconstruction by lateral lumbar interbody fusion at the L1–2 level. Robotic posterior T10–S2 fusion was then added to provide stability to the construct and address the patient’s scoliotic deformity. No complications were noted, and the patient was followed until 1 year after the operation with a favorable clinical and radiological result. LESSONS Revision of a prior failed L5–S1 TLIF with an LALIF approach has technical challenges but may be advantageous for single position anterior column reconstruction under certain conditions.
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Affiliation(s)
| | | | | | - Ivan Cheng
- Orthopedic Surgery, Stanford University, Stanford, California; and
| | - Martin N. Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital, St. Gallen, Switzerland
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Singh S, McCloskey K, Ahmad HS, Turlip R, Ghenbot Y, Sinha S, Yoon JW. Minimally Invasive Deformity Correction Technique: Initial Case Series of Anterior Lumbar Interbody Fusion at L5–S1 for Multi-Level Lumbar Interbody Fusion in a Lateral Decubitus Position. World Neurosurg 2022; 162:e416-e426. [DOI: 10.1016/j.wneu.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
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