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Sadhwani S, Brown M, Dalton J, Nivar I, Henzes J, Marcinko M, Maugle T. Single Position Lateral versus Prone Transpsoas Lateral Interbody Fusion Inclusive of L4-L5: A Single Surgeon Experience Examining Early Postoperative Outcomes. World Neurosurg 2024; 187:e460-e464. [PMID: 38663733 DOI: 10.1016/j.wneu.2024.04.109] [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: 01/25/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The transpsoas lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive lumbar spine approach that provides indirect neural decompression, improved sagittal alignment, and a high fusion rate. Typically accompanied by posterior pedicle screw insertion, there has been interest in performing LLIF in a single position to decrease cost and time under anesthesia. However, there is a paucity of direct comparisons between single-position LLIF via prone versus lateral decubitus positioning. Therefore, this study aims to compare the outcomes of a single surgeon performing prone versus lateral single-position LLIF, inclusive of the L4-L5 level. METHODS A retrospective review was performed of a consecutive case series of patients who underwent either prone or lateral, single-position LLIF by a single surgeon. All cases involved the L4-L5 level. Demographic data, perioperative details, clinical outcomes, and preoperative and postoperative lumbar lordosis were recorded. RESULTS Sixty-three patients underwent lateral and 16 patients underwent prone single-position LLIF. Demographics and average interbody size were similar between groups. Operative time, change in lumbar lordosis, and length of hospital stay did not differ between the 2 positions. Both groups performed similarly in terms of preoperative and postoperative visual analog score pain score and complications. Patients who underwent lateral position LLIF ambulated farther on postoperative day 1 (250 feet vs. 200 feet, P = 0.015). Average time to follow up was 53 weeks. CONCLUSIONS This study demonstrates promising preliminary results indicating that single-position LLIF performs well, even at the L4-L5 level, in both the prone and lateral positions.
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Affiliation(s)
- Shaan Sadhwani
- Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA.
| | - Michael Brown
- Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA
| | - Jonathan Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Isaac Nivar
- Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA
| | - Jamie Henzes
- Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA
| | - Michael Marcinko
- Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA
| | - Tyson Maugle
- Orthopedic Institute of Pennsylvania, Harrisburg, Pennsylvania, USA
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Hasan S, Al-Jamal M, Miller A, Higginbotham DO, Cavazos DR, Waheed M, Saleh E, McCarty SA. Efficacy and Outcome Measurement of iFactor/ABM/P-15 in Lumbar Spine Surgery: A Systematic Review. Global Spine J 2024; 14:1422-1433. [PMID: 37994908 DOI: 10.1177/21925682231217253] [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: 11/24/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To determine the efficacy and overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. METHODS We performed a search of the Cochrane Library, Medline Ovid, PubMed, and SCOPUS databases from inception until August 2023. Eligible studies included outcomes of patients receiving iFactor following lumbar spine surgery. The primary outcomes of interest were fusion rates and iFactor efficacy after lumbar surgery in patients who received iFactor. Secondary outcomes included patient-reported outcomes and complication rates. RESULTS A total of 766 titles were initially screened. After inclusion criteria were applied, 5 studies (388 patients) were included, which measured overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. iFactor/ABM/P-15 facilitated significantly faster bone development in various procedures while maintaining favorable clinical outcomes compared to traditional grafts. CONCLUSIONS This systematic review found that iFactor/ABM/P-15 use for lumbar spine surgery maintains similar managing patient-reported outcomes relative to other grafting methods. In regard to rates of fusion, iFactor/ABM/P-15 showed a significantly faster rate of fusion when compared to traditional grafts including allograft, autograft, demineralized bone matrix (DBM), and recombinant human bone morphogenetic protein-2 (rhBMP-2). Future multicenter randomized control trials with larger sample sizes are recommended to further assess iFactor/ABM/P-15 efficacy in lumbar spine surgery.
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Affiliation(s)
- Sazid Hasan
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Malik Al-Jamal
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Alex Miller
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Daniel R Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Muhammad Waheed
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Ehab Saleh
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Scott A McCarty
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
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Shost MD, Barksdale E, Huerta M, Seals K, Rabah N, Butt B, Steinmetz M. A retrospective analysis of perioperative complications of lateral approach lumbar interbody fusion in patients with prior abdominal surgery or a history of colonic inflammatory disease. Spine J 2024:S1529-9430(24)00110-4. [PMID: 38518920 DOI: 10.1016/j.spinee.2024.03.005] [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: 09/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND CONTEXT Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disk space by passing through a retroperitoneal corridor either pre- or trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach. However, there is a paucity of evidence on the prevalence of surgical complications following lateral fusion surgery in patients with a history of abdominal surgery. PURPOSE The primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study. OUTCOME MEASURES The primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration. METHODS The electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria). RESULTS Of 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02-2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20-1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p>.05). CONCLUSION Though retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.
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Affiliation(s)
- Michael D Shost
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Edward Barksdale
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Mina Huerta
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Karrington Seals
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Nicholas Rabah
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| | - Bilal Butt
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| | - Michael Steinmetz
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH, USA.
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Roca AM, Anwar FN, Khosla I, Medakkar SS, Loya AC, Sayari AJ, Lopez GD, Singh K. Utility of preoperative comorbidity burden on PROMIS outcomes after lumbar decompression: Cohort matched analysis. J Clin Neurosci 2024; 121:23-27. [PMID: 38335824 DOI: 10.1016/j.jocn.2024.02.001] [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: 01/02/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
The influence of Charlson Comorbidity Index (CCI) burden on Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes following lumbar decompression (LD) is limited. The objective of this study is to evaluate CCI burden impact on PROMIS outcomes. Retrospective review of elective LD excluding revision or surgeries for infectious, malignant, or traumatic reasons. Demographics and PROMIS scores collected preoperatively and postoperatively up to 2 years included: PROMIS-Physical Function (PF)/Sleep Disturbance (SD)/Pain Interference (PI)/Anxiety (A), VR-12 Physical/Mental Health Composite scores (VR-12 PCS/MCS)/Oswestry Disability Index (ODI). Patients were divided into two groups based on their preoperative CCI score <3 (mild) or ≥4 (moderate to severe). Descriptive statistical analysis and MCID achievement rate calculations were conducted. A total of 182 patients were included: 93 CCI < 3 and 88 CCI ≥ 4. No significant differences were reported across preoperative PROMIS/legacy PROMs or final follow-up (p > 0.05, all). At 6-weeks, VR-12 PCS and ΔPROM scores indicated improved physician function in the CCI < 3 group (p = 0.020 and p = 0.040, respectively). Significant PROMIS-A ΔPROM score at final post-op was noted for CCI < 3 group (p = 0.026). MCID achievement demonstrated no significant differences for PROMIS outcomes and legacy PROMs. Results demonstrated that PROMIS outcomes were not impacted by a greater baseline comorbidity burden. At 6-weeks, the physical function scores were improved for the lower CCI group, and at final reported less anxiety. Our data suggests that comorbidity burden has a limited effect on PROMIS and legacy outcomes in patients undergoing LD.
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Affiliation(s)
- Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
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