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Zhang X, Wang Y, Zhang W, Liu S, Liu Z, Wang K, Wu H. Perioperative Clinical Features and Long-term Prognosis After Oblique Lateral Interbody Fusion (OLIF), OLIF With Anterolateral Screw Fixation, or OLIF With Percutaneous Pedicle Fixation: A Comprehensive Treatment Strategy for Patients With Lumbar Degenerative Disease. Neurospine 2023; 20:536-549. [PMID: 37401071 PMCID: PMC10323359 DOI: 10.14245/ns.2244954.477] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/16/2023] [Accepted: 03/09/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE To compare the efficacy of oblique lateral interbody fusion (OLIF), OLIF combined with anterolateral screw fixation (OLIF-AF), and OLIF combined with percutaneous pedicle screw fixation (OLIF-PF) in the treatment of single-level or 2-level degenerative lumbar disease. METHODS Between January 2017 and 2021, 71 patients were treated with OLIF and combined OLIF. The demographic data, clinical outcomes, radiographic outcomes, and complications were compared among the 3 groups. RESULTS The operative time and intraoperative blood loss in the OLIF (p<0.05) and OLIF-AF (p<0.05) groups were lower than in the OLIF-PF group. Posterior disk height improvement in the OLIF-PF group was better than in the OLIF (p<0.05) and OLIF-AF (p<0.05) groups. In terms of foraminal height (FH), the OLIF-PF group was significantly better than the OLIF group (p<0.05), but there was no significant difference between the OLIF-PF and OLIF-AF groups (p>0.05) or between the OLIF and OLIF-AF groups (p>0.05). There were no significant differences in fusion rates, the incidence of complications, lumbar lordosis, anterior disc height, and cross-sectional area among the 3 groups (p>0.05). The OLIF-PF group had significantly lower rates of subsidence than the OLIF group (p<0.05). CONCLUSION OLIF remains a viable option with similar patient-reported outcomes and fusion rates compared with surgeries that include lateral and posterior internal fixation while greatly reducing the financial burden, intraoperative time, and intraoperative blood loss. OLIF has a higher subsidence rate than lateral and posterior internal fixation, but most subsidence is mild and has no adverse effect on clinical and radiographic outcomes.
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Affiliation(s)
- Xiangyu Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yutian Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weikang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sun D, Liang W, Hai Y, Yin P, Han B, Yang J. OLIF versus ALIF: Which is the better surgical approach for degenerative lumbar disease? 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 2023; 32:689-699. [PMID: 36587140 DOI: 10.1007/s00586-022-07516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/06/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical and radiographical outcomes between OLIF and ALIF in treating lumbar degenerative diseases. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies. Changes in disc height (DH), segmental lordosis angle (SLA), lumbar lordosis (LL), visual analogue scale (VAS) score, and Oswestry disability index (ODI) between baseline and final follow-up, along with other important surgical outcomes, were assessed and analysed. Data on the global fusion rate and main complications were collected and compared. RESULTS Approximately, 2041 patients from 36 studies were included, consisting of 1057 patients who underwent OLIF and 984 patients who underwent ALIF. The results reveal no significant difference in DH, SLA, VAS score, and ODI between the two groups (all P > 0.05). The operation time, estimated blood loss, and length of hospital stay were also comparable between the two groups. Over 90% of the fusion rate was achieved in both groups. The OLIF group showed a higher complication rate than the ALIF group (OLIF 18.83% vs ALIF 7.32%). CONCLUSIONS OLIF leads to a higher complication rate, with the most notable complication being cage subsidence. Both OLIF and ALIF are effective treatments for degenerative lumbar diseases and have similar therapeutic effects. ALIF was expected to be more expensive for patients because of the necessity of involving vascular surgeons.
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Affiliation(s)
- Duan Sun
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Weishi Liang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Peng Yin
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Bo Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
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Xue S, Wu T. Biomechanical Performances of an Oblique Lateral Interbody Fusion Cage in Models with Different Bone Densities: A Finite Element Analysis. Indian J Orthop 2023; 57:86-95. [PMID: 36660489 PMCID: PMC9789258 DOI: 10.1007/s43465-022-00775-5] [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: 03/19/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Study Design Finite element models of the L3-S1 vertebrae were reconstructed using computed tomography scans. Objective We compared the biomechanical performances of an oblique lateral interbody fusion (OLIF) cage in different bone density mode. Summary of Background Data Low bone density is an els.key factor limiting the use of stand-alone OLIF cage. Methods Four models-intact (M0), normal bone density with OLIF (M1), bone mass loss with OLIF (M2), and osteoporotic with OLIF (M3)-were created based on 3-dimensional scans. Flexion, extension, and lateral bending movements (each lasting 10 N·m) were performed on the superior surface of the L3 vertebra with a compressive preload of 500 N. Range of motion (ROM), peak stresses in the L4-5 cortical endplates, cage stress, and adjacent intervertebral disk stress were evaluated. Results ROMs during different physiological movements were similar to those reported by previous researchers. Compared with that in M0, L4-5 ROMs of all movements decreased in M1, M2 and M3, most evidently in M3. Stress distribution in the cortical endplates rose to 7.8% in M1 and M2, even 16.2% in M3. Cage stress increased by less than 8.1% in M1 and M2, but by 25.3% in M3, especially in the movements of extension and right rotation. Compared with that in M0, L3-4 and L5-S1 intervertebral disk stress increased with bone density in all the other models, by up to 69.8% and 98.3%, respectively. As osteoporosis worsened, stress in the adjacent intervertebral disk also increased. Conclusion Stand-alone OLIF in M3 is not recommended because of the risk of cage subsidence. OLIF in M1 and M2 achieved similar results in various lumbar spine movements. In M1 and M2 model (T > - 2.5), the L4-L5 showed reduced mobility in all directions, increased rigidity, limited cage displacement, lessened deformation, and better stability.
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Affiliation(s)
- Shuangtao Xue
- Darpartment of Orthopaedics, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, 241001 Anhui China
| | - Tianliang Wu
- Darpartment of Orthopaedics, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, 241001 Anhui China
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Zhang Y, Liu C, Ge X. Clinical and radiographic outcomes of stand-alone oblique lateral interbody fusion in the treatment of adult degenerative scoliosis: a retrospective observational study. BMC Musculoskelet Disord 2022; 23:1133. [PMID: 36575399 PMCID: PMC9793660 DOI: 10.1186/s12891-022-06035-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/28/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Open fusion and posterior instrumentation has traditionally been the treatment for adult degenerative scoliosis (ADS). However, minimally invasive treatment such as oblique lateral interbody fusion (OLIF) technique was developed as a new therapeutic method for the treatment of ADS. In addition, it is associated with decreased blood loss and shorter operative time without posterior instrument. The purpose of this study was to evaluate the efficiency of stand-alone OLIF for the treatment of ADS in terms of clinical and radiological results. METHODS A total of 30 patients diagnosed with ADS who underwent stand-alone OLIF in our hospital from July 2017 to September 2018 were enrolled in the study. Scores from the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) obtained preoperatively and at the final follow-up were compared. Radiography and computed tomography were performed preoperatively and at the final follow-up. The coronal cobb angle, lumbar lordosis, disc height, sacral slope, pelvic incidence and Pelvic tilt were recorded at each time point. RESULTS The study cohort comprised 30 patients with a mean age of 64.5 ± 10.8 years and mean follow-up of 19.3 ± 4.2 months. The mean operative time was 96.8 ± 29.4 minutes and the mean estimated blood loss volume was 48.7 ± 9.4 ml. The mean coronal Cobb angle was corrected from 15.0° ± 3.7° preoperatively to 7.2° ± 3.1° postoperatively and 7.2° ± 3.3° at final follow-up (P < 0.0001). Lumbar lordosis significantly improved from 32.2° ± 11.3° preoperatively to 40.3° ± 11.8° postoperatively and 40.7° ± 11.0° at final follow-up (P < 0.01). The respective mean sacral slope and pelvic tilt improved from 26.1° ± 8.1° and 25.1° ± 6.9° preoperatively to 34.3° ± 7.4° and 19.2° ± 5.7° at final follow-up (P < 0.001). The mean disc height (defined as the mean of the anterior and posterior intervertebral disc heights) increased from 0.7 ± 0.3 cm preoperatively to 1.1 ± 0.2 cm at final follow-up (P < 0.0001). The interbody fusion rate on CT was 93.3%. The mean VAS pain score improved from 5.3 ± 0.6 before surgery to 2.3 ± 0.6 at final follow-up (P < 0.001). The mean ODI improved from 29.9% ± 6.8% preoperatively to 12.8% ± 2.4% at final follow-up (P < 0.001). CONCLUSIONS Stand-alone OLIF is an effective and safe option for treating ADS in carefully selected patients. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052419).
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Affiliation(s)
- Yu Zhang
- grid.27255.370000 0004 1761 1174School of Medicine, Shandong University, No. 44 Cultural West Road, Lixia District, Jinan City, 250012 Shandong Province China ,grid.27255.370000 0004 1761 1174Anhui Provincial Hospital, Shandong University, Hefei, 230001 Anhui China ,grid.443626.10000 0004 1798 4069Spine Research Center of Wannan Medical College, No.22 Wenchang West Road, Wuhu, 241001 Anhui China ,grid.452929.10000 0004 8513 0241Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001 Anhui China
| | - Chen Liu
- grid.443626.10000 0004 1798 4069Spine Research Center of Wannan Medical College, No.22 Wenchang West Road, Wuhu, 241001 Anhui China ,grid.452929.10000 0004 8513 0241Department of Spine Surgery, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001 Anhui China
| | - Xin Ge
- Department of Spine Surgery, Anqing first people’s Hospital, No. 187 Huazhong Road, Anqing, 241001 Anhui China
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Bhatti AUR, Cesare J, Wahood W, Alvi MA, Onyedimma CE, Ghaith AK, Akinnusotu O, El Sammak S, Freedman BA, Sebastian AS, Bydon M. Assessing the differences in operative and patient-reported outcomes between lateral approaches for lumbar fusion: a systematic review and indirect meta-analysis. J Neurosurg Spine 2022; 37:498-514. [PMID: 35453114 DOI: 10.3171/2022.2.spine211164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior-to-psoas lumbar interbody fusion (ATP-LIF), more commonly referred to as oblique lateral interbody fusion, and lateral transpsoas lumbar interbody fusion (LTP-LIF), also known as extreme lateral interbody fusion, are the two commonly used lateral approaches for performing a lumbar fusion procedure. These approaches help overcome some of the technical challenges associated with traditional approaches for lumbar fusion. In this systematic review and indirect meta-analysis, the authors compared operative and patient-reported outcomes between these two select approaches using available studies. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, the authors conducted an electronic search using the PubMed, EMBASE, and Scopus databases for studies published before May 1, 2019. Indirect meta-analysis was conducted on fusion rate, cage movement (subsidence plus migration), permanent deficits, and transient deficits; results were depicted as forest plots of proportions (effect size [ES]). RESULTS A total of 63 studies were included in this review after applying the exclusion criteria, of which 26 studies investigated the outcomes of ATP-LIF, while 37 studied the outcomes of LTP-LIF. The average fusion rate was found to be similar between the two groups (ES 0.97, 95% CI 0.84-1.00 vs ES 0.94, 95% CI 0.91-0.97; p = 0.561). The mean incidence of cage movement was significantly higher in the ATP-LIF group compared with the LTP-LIF group (stand-alone: ES 0.15, 95% CI 0.06-0.27 vs ES 0.09, 95% CI 0.04-0.16 [p = 0.317]; combined: ES 0.18, 95% CI 0.07-0.32 vs ES 0.02, 95% CI 0.00-0.05 [p = 0.002]). The mean incidence of reoperations was significantly higher in patients undergoing ATP-LIF than in those undergoing LTP-LIF (ES 0.02, 95% CI 0.01-0.03 vs ES 0.04, 95% CI 0.02-0.07; p = 0.012). The mean incidence of permanent deficits was similar between the two groups (stand-alone: ES 0.03, 95% CI 0.01-0.06 vs ES 0.05, 95% CI 0.01-0.12 [p = 0.204]; combined: ES 0.03, 95% CI 0.01-0.06 vs ES 0.03, 95% CI 0.00-0.08 [p = 0.595]). The postoperative changes in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were both found to be higher for ATP-LIF relative to LTP-LIF (VAS: weighted average 4.11 [SD 2.03] vs weighted average 3.75 [SD 1.94] [p = 0.004]; ODI: weighted average 28.3 [SD 5.33] vs weighted average 24.3 [SD 4.94] [p < 0.001]). CONCLUSIONS These analyses indicate that while both approaches are associated with similar fusion rates, ATP-LIF may be related to higher odds of cage movement and reoperations as compared with LTP-LIF. Furthermore, there is no difference in rates of permanent deficits between the two procedures.
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Affiliation(s)
- Atiq Ur Rehman Bhatti
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph Cesare
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4University of Wisconsin, Madison, Wisconsin
| | - Waseem Wahood
- 5Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida; and
| | - Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chiduziem E Onyedimma
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abdul Karim Ghaith
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sally El Sammak
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brett A Freedman
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arjun S Sebastian
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Wang Y, Wang J, Tu S, Li S, Yi J, Zhao H, Qiao H, Yan K, Liao B. Biomechanical Evaluation of an Oblique Lateral Locking Plate System for Oblique Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurg 2022; 160:e126-e141. [PMID: 35031519 DOI: 10.1016/j.wneu.2021.12.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The oblique lateral locking plate system (OLLPS) is a novel internal fixation with a locking and reverse pedicle track screw configuration designed for oblique lumbar interbody fusion (OLIF). The OLLPS is placed in a single position through the oblique lateral surgical corridor to reduce operative time and complications associated with prolonged anesthesia and prone positioning. The purpose of this study was to verify the biomechanical effect of the OLLPS. METHODS An intact finite element model of L1-S1 (intact) was established based on computed tomography images of a healthy male volunteer. The L4-L5 intervertebral space was selected as the surgical segment. The surgical models were established separately based on OLIF surgical procedures and different internal fixations: 1) stand-alone OLIF (SA); 2) OLIF with a 2-screw lateral plate; 3) OLIF with a 4-screw lateral plate; 4) OLIF with OLLPS; and 5) OLIF with bilateral pedicle screw fixation (BPS). After validation of the intact model, physiologic loads were applied to the superior surface of L1 to simulate motions such as flexion, extension, left bending, right bending, left rotation, and right rotation. The evaluation indices included the L4/5 range of motion, the L4 maximum displacement, and the maximum stresses of the superior and inferior end plates, the cage, and the supplemental fixation. RESULTS During OLIF surgery, the OLLPS provided multiplanar stability similar to that provided by BPS. Compared with 2-screw lateral plate and 4-screw lateral plate, OLLPS had better biomechanical properties in terms of enhancing the instant stability of the surgical segment, reducing the stress on the superior and inferior end plates of the surgical segment, and decreasing the risk of cage subsidence. CONCLUSIONS With a minimally invasive background, the OLLPS can be used as an alternative to BPS in OLIF and it has better prospects for clinical promotions and applications.
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Affiliation(s)
- Yinge Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China; Department of Orthopedics, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Jiajia Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Sha Tu
- Department of Nutrition, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Shuang Li
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Jiangpu Yi
- 3D Printing Research Center, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Haien Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Huanhuan Qiao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Kang Yan
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
| | - Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
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Kai W, Cheng C, Yao Q, Zhang C, Jian F, Wu H. Oblique Lumbar Interbody Fusion Using a Stand-Alone Construct for the Treatment of Adjacent-Segment Lumbar Degenerative Disease. Front Surg 2022; 9:850099. [PMID: 35433807 PMCID: PMC9010501 DOI: 10.3389/fsurg.2022.850099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Adjacent-segment disease (ASD) is common in patients undergone previous lumbar fusion. A typical revision treatment from posterior approach requires management of postoperative scar tissue and previously implanted instrumentation. An oblique lumbar interbody fusion (OLIF) approach allows surgeon to reduce the potential risk of posterior approach. This study aimed to analyze the clinical and radiographic efficacy of stand-alone OLIF for the treatment of lumbar adjacent-segment disease. Methods A total of 13 consecutive patients who underwent stand-alone OLIF for the treatment of adjacent-segment disease from December 2016 to January 2019 were reviewed. Visual analog scale (VAS) of back pain and leg pain and the Oswestry Disability Index (ODI) before surgery and at last postoperative clinic visits were obtained. Radiography, CT and MRI before and at last follow-up after surgery was evaluated in all patients. Results During the study period, 13 cases were successfully treated with stand-alone OLIF. The mean follow-up was 17.7 ± 8.3 months. The back pain VAS improved from 6.2 ± 1.0 to 2.0 ± 1.1 (P < 0.01), and the leg pain VAS improved from 7.0 ± 1.9 to 1.0 ± 0.9 (P < 0.01). ODI improved from 28.0 ± 7.5 to 10.8 ± 4.0 (P < 0.01). The disc height (DH) increased from 9 ± 2 to 12 ± 2 mm (P < 0.01), the cross-sectional area (CSA) of spinal canal increased from 85 ± 26 to 132 ± 24 mm2 (P < 0.01), the foraminal height increased from 17 ± 2 to 21 ± 3 mm (P < 0.01) and the CSA of foramen increased from 95 ± 25 to 155 ± 36 mm2 (P < 0.01). Cage subsidence was observed in 2 cases. Conclusions Stand-alone OLIF provides a safe and effective alternative way to treat ASD.
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Buckland AJ, Ashayeri K, Leon C, Cheng I, Thomas JA, Braly B, Kwon B, Eisen L. Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2175-2187. [PMID: 35235051 DOI: 10.1007/s00586-022-07127-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/22/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Circumferential (AP) lumbar fusion surgery is an effective treatment for degenerative and deformity conditions of the spine. The lateral decubitus position allows for simultaneous access to the anterior and posterior aspects of the spine, enabling instrumentation of both columns without the need for patient repositioning. This paper seeks to outline the anatomical and patient-related considerations in anterior column reconstruction of the lumbar spine from L1-S1 in the lateral decubitus position. METHODS We detail the anatomic considerations of the lateral ALIF, transpsoas, and anterior-to-psoas surgical approaches from surgeon experience and comprehensive literature review. RESULTS Single-position AP surgery allows simultaneous access to the anterior and posterior column and may combine ALIF, LLIF, and minimally invasive posterior instrumentation techniques from L1-S1 without patient repositioning. Careful history, physical examination, and imaging review optimize safety and efficacy of lateral ALIF or LLIF surgery. An excellent understanding of patient spinal and abdominal anatomy is necessary. Each approach has relative advantages and disadvantages according to the disc level, skeletal, vascular, and psoas anatomy. CONCLUSIONS A development of a framework to analyze these factors will result in improved patient outcomes and a reduction in complications for lateral ALIF, transpsoas, and anterior-to-psoas surgeries.
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Affiliation(s)
| | - Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, 462 1st Avenue, Suite 7S4, New York, NY, 10016, USA.
| | - Carlos Leon
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC, USA
| | - Brett Braly
- Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA
| | - Brian Kwon
- Division of Spine Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Leon Eisen
- NYU Langone Orthopedic Hospital, New York, NY, USA
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Zhu L, Wang P, Zhang L, Feng X, Zhang W. Comparison of Minimally Invasive Transforaminal and Anterolateral Lumbar Interbody Fusion for Treatment of Low-grade Lumbar Spondylolisthesis. Clin Spine Surg 2022; 35:E285-E291. [PMID: 34654771 DOI: 10.1097/bsd.0000000000001256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The aim was to compare the clinical outcomes, radiographic parameters and perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterolateral lumbar interbody fusion (ALLIF) for the treatment of low-grade lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA Both MIS-TLIF and ALLIF are minimally invasive surgical methods for the treatment of lumbar degenerative diseases. However, few studies have compared the results of MIS-TLIF and ALLIF for the treatment of low-grade lumbar spondylolisthesis. MATERIALS AND METHODS A total of 112 patients with low-grade lumbar spondylolisthesis were divided as MIS-TLIF group (n=59, mean age 61.7 y) or ALLIF group (n=53, mean age 60.1 y) according to the treatment method. The operative time, intraoperative blood loss, and length of hospital stay were recorded. Besides, clinical outcomes were evaluated by visual analog scale and Oswestry disability index score. Radiographic parameters were assessed by disc height, lumbar lordosis, segmental lordosis, and fusion rate. RESULTS ALLIF significantly reduced operative time, intraoperative blood loss, and length of hospital stay compared with MIS-TLIF. Moreover, ALLIF was superior to MIS-TLIF in the early postoperative relief of back pain and recovery of lumbar function. However, there were no significant differences in the clinical outcomes at final follow-up between the 2 groups. The amount of change between preoperative and postoperative disc height, lumbar lordosis and segmental lordosis in ALLIF group were significantly higher than those in MIS-TLIF group (P<0.05). However, there were no significant differences in fusion rate and incidence of complications between the 2 groups. CONCLUSIONS This study indicated that the final follow-up clinical outcomes, complication rate of ALLIF were similar to MIS-TLIF for the treatment of low-grade lumbar spondylolisthesis. However, ALLIF showed advantages in less surgical trauma, faster recovery, early postoperative relief of back pain, and radiographic parameters improvement.
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Affiliation(s)
- Lei Zhu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou
| | - Pingchuan Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou
| | - Wenjie Zhang
- Department of Orthopedics, International Zhuang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, China
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Treatment of one-level degenerative lumbar spondylolisthesis with severe stenosis by oblique lateral interbody fusion: Clinical and radiological results after a minimal 1-year follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zhu L, Zhang L, Shan Y, Feng X, Zhang W. Analysis of Hidden Blood Loss and its Risk Factors in Oblique Lateral Interbody Fusion Surgery. Clin Spine Surg 2021; 34:E501-E505. [PMID: 33783370 DOI: 10.1097/bsd.0000000000001177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to evaluate the volume of hidden blood loss (HBL) and analyze its influential factors in single level oblique lateral interbody fusion (OLIF) surgery. SUMMARY OF BACKGROUND DATA OLIF is a minimally invasive spine surgery and is increasingly used to treat lumbar degenerative disk diseases. It is generally believed that there is less bleeding during OLIF. However, HBL during the perioperative period is commonly ignored. MATERIALS AND METHODS From January 2018 to December 2019, a total of 70 patients underwent single level OLIF surgery were retrospectively reviewed. The values of preoperative and postoperative hematocrit (Hct) were recorded to reckon HBL in accordance with Gross formula. The influential factors included sex, age, height, weight, body mass index, hypertension, diabetes mellitus, American Society of Anesthesiologists classification, disease etiology, surgery type, operative time, surgical corridor distance, psoas cross-sectional area, thickness of abdominal wall soft tissue, coagulation panel value, platelet count, values of Hct and hemoglobin, and intraoperative blood loss. Independent sample t test, Pearson correlation, Spearman correlation, and multivariate linear regression analysis were performed to investigate the risk factors related to HBL. RESULTS The average volume of HBL was 809 mL and the average hemoglobin loss was 27.1 g/L in OLIF procedure. Multiple linear regression analysis revealed that thickness of abdominal wall soft tissue was the independent risk factor for HBL (P=0.008). Whereas age (P=0.414), activated partial thromboplastin time (P=0.314), preoperative value of Hct (P=0.854), disease etiology (P=0.362), operative time (P=0.389), and intraoperative blood loss (P=0.912) were not statistically associated with HBL. CONCLUSIONS HBL was substantial and the average volume of HBL was 809 mL in single level OLIF surgery. The thickness of abdominal wall soft tissue was the risk factor of HBL. Accurate assessment of HBL can prevent perioperative complications and ensure patients' safety.
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Affiliation(s)
- Lei Zhu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province
| | - Yuzhou Shan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province
| | - Wenjie Zhang
- Department of Orthopedics, International Zhuang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
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Analysis of Spino-Pelvic Parameters and Segmental Lordosis with L5-S1 Oblique Lateral Interbody Fusion at the Bottom of a Long Construct in Circumferential Minimally Invasive Surgical Correction of Adult Spinal Deformity. World Neurosurg 2019; 130:e1077-e1083. [DOI: 10.1016/j.wneu.2019.07.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
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