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Wu JJ, Chang ZQ. Treatment of refractory thoracolumbar spine infection by thirteen times of vacuum sealing drainage: A case report. World J Orthop 2025; 16:101073. [PMID: 40124728 PMCID: PMC11924023 DOI: 10.5312/wjo.v16.i3.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 01/07/2025] [Accepted: 02/12/2025] [Indexed: 03/12/2025] Open
Abstract
BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage (VSD) surgeries were treated. CASE SUMMARY The patient underwent a total of 13 procedures within our medical facility, including five performed under local anesthesia and eight performed under general anesthesia. The source of the ailment was ultimately identified as Enterobacter cloacae. After the last procedure, the patient's symptoms were alleviated, and the recovery process was satisfactory. Three months post-operation, the Japanese Orthopaedic Association scores had improved to 100%. Imageological examination revealed a satisfactory position of internal fixation, and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results. CONCLUSION The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection, providing an alternative to traditional surgery.
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Affiliation(s)
- Jun-Jie Wu
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zheng-Qi Chang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
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Zhong Z, Xiong M, Deng L, Zeng J, Ai G, Xiao Q. CT anatomical study of extreme lateral interbody fusion in thoracic spine. Medicine (Baltimore) 2024; 103:e38863. [PMID: 39058888 PMCID: PMC11272364 DOI: 10.1097/md.0000000000038863] [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: 11/15/2023] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Extreme Lateral Interbody Fusion (XLIF) is currently used in the clinical treatment of thoracic spine disorders and has achieved desirable results. In this study, we selected CT images of the thoracic spine from 54 patients and divided the intervertebral spaces into six regions (A, I, II, III, IV, P) using the Moro method. We observed the adjacent relationships between the thoracic spine and surrounding tissues such as the scapula, esophagus, thoracic aorta, and superior vena cava. We made four main findings: firstly, when the scapulae were symmetrical on both sides, over 80% of patients had the T1-4 II-III region obstructed by the scapulae; secondly, when the esophagus was located on the left side of the vertebral body, 3.7% to 24.1% of patients had the T4-9 region located in the II-III zone; furthermore, when the thoracic aorta was on the left side of the vertebral body, over 80% of individuals in the T4-9 segment occupied the II-III region, with the values being 55.5% and 20.4% for T9/10 and T10/11, respectively; finally, the superior vena cava was located on the right side of the T4/5 vertebra, with 3.7% of individuals having it in the II-III region, while on the left side of T5-9, 3.7% to 18.5% of individuals had it in the II-III region. Based on these findings, we suggest that XLIF should not be performed on the T1-4 vertebrae due to scapular obstruction. Selecting the left-sided approach for XLIF in the T4-11 segments may risk injuring the thoracic aorta, esophagus, and superior vena cava, while the T11/12 segment is considered safe and feasible. Choosing the right-sided approach for XLIF may pose a risk of injuring the superior vena cava in the T4/5 segment, but it is safe and feasible in the T5-12 segments.
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Affiliation(s)
- Zhenyu Zhong
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Moliang Xiong
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Liang Deng
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jihuan Zeng
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gangtong Ai
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qiang Xiao
- Department of Orthopaedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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DeLong CA, Bashti M, Di L, Shah SS, Jaman E, Basil GW. Management of Refractory Post-operative Osteomyelitis and Discitis: A Case Report. Cureus 2024; 16:e52620. [PMID: 38374846 PMCID: PMC10875402 DOI: 10.7759/cureus.52620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Vertebral osteomyelitis/discitis is a relatively rare disease but is a known potential complication of spinal surgical intervention. In general, the first-line treatment for this condition is targeted antibiotic therapy with surgical intervention only utilized in refractory cases with evidence of extensive damage, structural instability, or abscess formation. However, surgical best practices have not been established for osteomyelitis, including indications for anterior lateral interbody fusion (ALIF), posterior lateral interbody fusion (PLIF), or direct lateral interbody fusion (DLIF). This case provides a discussion of the indications that led to a direct lateral approach in the setting of refractory osteomyelitis/discitis, supporting factors that led to its success, and the efficacy of utilizing intraoperative neuromonitoring in cases of infection.
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Affiliation(s)
- Chase A DeLong
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Malek Bashti
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Sumedh S Shah
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Emade Jaman
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Gregory W Basil
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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Lai O, Li H, Chen Q, Hu Y, Chen Y. Comparison of staged LLIF combined with posterior instrumented fusion with posterior instrumented fusion alone for the treatment of adult degenerative lumbar scoliosis with sagittal imbalance. BMC Musculoskelet Disord 2023; 24:260. [PMID: 37013494 PMCID: PMC10069051 DOI: 10.1186/s12891-023-06340-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: 12/28/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND To retrospectively compare the clinical and radiological outcomes of staged lateral lumbar interbody fusion (LLIF) combined with posterior instrumented fusion(PIF)with PIF alone for the treatment of adult degenerative lumbar scoliosis (ADLS) with sagittal imbalance. METHODS ADLS patients with sagittal imbalance underwent corrective surgery were included and divided into staged group (underwent multilevel LLIF in the first-stage and PIF in the second-stage) and control group (PIF alone). The clinical and radiological outcomes were evaluated and compared between the two groups. RESULTS Forty-five patients with an average age of 69.7±6.3 years were enrolled, including 25 in the staged group and 20 in the control group. Compared with preoperative values, patients in both groups achieved significant improvement in terms of ODI, VAS back, VAS leg and spinopelvic parameters after surgery, which were maintained well during the follow-up period. Compared with control group, total operative time in the staged group was longer, but the amounts of blood loss and blood transfusion were reduced. The average posterior fixation segments were 6.20±1.78 in the staged group and 8.25±1.16 in the control group (P<0.01), respectively. Posterior column osteotomy (PCO) was performed in 9 patients (36%) in the staged group, while PCO and/or pedicle subtraction osteotomy were performed in 15 patients (75%) in the control group (P<0.01). There was no difference in complications between the two groups. CONCLUSION Both surgical strategies were effective for the treatment of ADLS with sagittal imbalance. However, staged treatment was less invasive, which reduced the number of posterior fixation segments and osteotomy requirement.
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Affiliation(s)
- Oujie Lai
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Hao Li
- Department of Spine Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
| | - Qixing Chen
- Department of Spine Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Yunling Chen
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
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Cui H, Chang Z, Yu X. Treatment of lumbar brucella spondylitis with negative pressure wound therapy via extreme lateral approach: A case report. Front Surg 2022; 9:974931. [PMID: 36386539 PMCID: PMC9643386 DOI: 10.3389/fsurg.2022.974931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022] Open
Abstract
Brucella spondylitis (BS) is a specific spinal infection. Surgical treatment is required for Brucella spondylitis that has caused neurological symptoms in the lower extremities and developed an intraspinal abscess. The main purpose of surgery is to remove the lesion and restore the stability of the spine. However, both the anterior approach and the posterior approach cannot completely remove the lesions, resulting in a low cure rate and a certain recurrence rate. Although anterior or posterior debridement is more thorough, it is unbearable for some patients with poor general condition. In this study, for the first time, a negative pressure wound therapy (NPWT) device was introduced into the intervertebral space through the extreme lateral approach to treat a patient with Brucella spondylitis. We summarize the treatment process, and discuss the feasibility and effectiveness of this surgical approach through 1-year follow-up.
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Affiliation(s)
| | | | - Xiuchun Yu
- Correspondence: Zhengqi Chang Xiuchun Yu
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Changoor S, Faloon MJ, Dunn CJ, Sahai N, Issa K, Moore J, Sinha K, Hwang KS, Emami A. Long-term Outcomes of Minimally Invasive Lateral Lumbar Interbody Fusion in the Treatment of Adult Scoliosis. Orthopedics 2022; 45:e134-e139. [PMID: 35112966 DOI: 10.3928/01477447-20220128-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The literature has shown the importance of long-term follow-up for adults with scoliosis treated surgically because complication and revision rates are high. The goal of this study was to determine long-term outcomes and complications of lateral lumbar interbody fusion (LLIF) with posterior instrumentation for adult patients with scoliosis. A retrospective review of our institution's database was performed to identify adult patients with scoliosis treated with LLIF between 2008 and 2013 with a minimum follow-up of 4 years. Medical records were reviewed for complications and revisions. Pre- and postoperative deformity Cobb angle measurements were taken as well as pelvic incidence (PI) and lumbar lordosis (LL). Functional outcome scores, including Oswestry Disability Index and visual analog scale score for back and leg pain, were assessed preoperatively and at follow-up. Standard binomial and categorical comparative analysis was performed. The 26 patients included had a mean age of 62 years, mean follow-up of 89 months, and mean of 1.8 levels per operation. Four patients (15.4%) required revisions. Mean deformity Cobb angle was 26° preoperatively and 14° postoperatively. Mean PI-LL mismatch was 11.7° preoperatively and 5.9° postoperatively. Nineteen (73%) patients had a PI-LL mismatch greater than 10° preoperatively, whereas only 2 (7.7%) had a mismatch postoperatively. Improvement was seen in all functional outcome scores. Long-term clinical results of LLIF for adults with deformity showed a low proportion of revision in the treatment of a condition with an established high rate of revision. The ability to reduce pelvic mismatch may further reduce the rate of revision. In this study, LLIF resulted in improved functional outcomes and patient satisfaction. [Orthopedics. 2022;45(3):e134-e139.].
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Louie PK, Vaishnav AS, Gang CH, Urakawa H, Sato K, Chaudhary C, Lee R, Mok JK, Sheha E, Lafage V, Qureshi SA. Development and Initial Internal Validation of a Novel Classification System for Perioperative Expectations Following Minimally Invasive Degenerative Lumbar Spine Surgery. Clin Spine Surg 2021; 34:E537-E544. [PMID: 34459472 DOI: 10.1097/bsd.0000000000001246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN This was a prospective consecutive clinical cohort study. OBJECTIVE The purpose of our study was to develop and provide an initial internal validation of a novel classification system that can help surgeons and patients better understand their postoperative course following the particular minimally invasive surgery (MIS) and approach that is utilized. SUMMARY OF BACKGROUND DATA Surgeons and patients are often attracted to the option of minimally invasive spine surgery because of the perceived improvement in recovery time and postsurgical pain. A classification system based on the impact of the surgery and surgical approach(es) on postoperative recovery can be particularly helpful. METHODS Six hundred thirty-one patients who underwent MIS lumbar/thoracolumbar surgery for degenerative conditions of the spine were included. Perioperative outcomes-operative time, estimated blood loss, postsurgical length of stay (LOS), 90-day complications, postoperative day zero narcotic requirement [in Morphine Milligram Equivalent (MME)], and need for intravenous patient-controlled analgesia (IV PCA). RESULTS Postoperative LOS and postoperative narcotic use were deemed most clinically relevant, thus selected as primary outcomes. Type of surgery was significantly associated with all outcomes (P<0.0001), except intraoperative complications. Number of levels for fusion was significantly associated with operative time, in-hospital complications, 24 hours oral MME, and the need for IV PCA and LOS (P<0.0001). Number of surgical approaches for lumbar fusion was significantly associated with operative time, 24 hours oral MME, need for IV PCA and LOS (P<0.001). Based on these parameters, the following classification system ("Qureshi-Louie classification" for MIS degenerative lumbar surgery) was devised: (1) Decompression-only; (2) Fusion-1 and 2 levels, 1 approach; (3) Fusion-1 level, 2 approaches; (4) Fusion-2 levels, 2 approaches; (5) Fusion-3+ levels, 2 approaches. CONCLUSIONS We present a novel classification system and initial internal validation to describe the perioperative expectations following various MIS surgeries in the degenerative lumbar spine. This initial description serves as the basis for ongoing external validation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Evan Sheha
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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8
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Pojskić M, Bopp M, Saß B, Kirschbaum A, Nimsky C, Carl B. Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci 2021; 11:brainsci11050646. [PMID: 34063546 PMCID: PMC8156391 DOI: 10.3390/brainsci11050646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Correspondence: ; Tel.: +49-64215869848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
| | - Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University of Marburg, 35043 Marburg, Germany;
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
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Von Glinski A, Elia CJ, Takayanagi A, Yilmaz E, Ishak B, Dettori J, Schell BA, Hayman E, Pierre C, Chapman JR, J.Oskouian R. Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma. Global Spine J 2021; 11:515-524. [PMID: 32875932 PMCID: PMC8119928 DOI: 10.1177/2192568220914883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Complication profiles for lateral approaches to the spine are well established. However, the influence of level of surgery on complication rates and subtypes are less well established. To determine risk factors for complications as determined by level and surgery type in patients undergoing a lateral (retroperitoneal or retropleural approach) to the thoracolumbar spine. METHODS All adult patients undergoing a lateral thoracolumbar fusion with or without posterior instrumentation performed at a single institution were identified. Primary outcomes assessed were presence of complication, complication subtype, and need for reoperation. The primary independent variables were spinal level (thoracic, thoracolumbar, or lumbar) and type of surgery (discectomy or corpectomy). Categorical outcomes were compared using chi-square test. Unadjusted and adjusted odds ratios for corpectomy status were calculated to determine risk of complication by level. P < .05 was considered statistically significant. RESULTS A total of 165 patients aged 18 to 75 years were identified as having undergone a lateral fusion. Complication rates were 28.6%, 36.4%, and 11% for thoracic, thoracolumbar, and lumbar lateral approach fusions, respectively. Under univariate analysis, patients undergoing lateral approach in the thoracic spine group had significantly higher rates of postoperative complications than those in the lumbar group (P = .005). After adjusting for corpectomy status, there was no difference in complication rates. CONCLUSIONS Lateral (retroperitoneal or retropleural) approaches to the thoracic and thoracolumbar spine may be used with complication rates comparable to well-established lumbar approaches. Extent of surgery (corpectomy vs discectomy) rather than level of surgery may represent the primary driver of complications.
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Affiliation(s)
- Alexander Von Glinski
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum,
Bochum, Germany,Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA,
USA,Alexander Von Glinski, Seattle Science
Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98122, USA.
| | - Christopher J. Elia
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA,Riverside University Health
Systems, Moreno Valley, CA, USA
| | | | - Emre Yilmaz
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum,
Bochum, Germany
| | - Basem Ishak
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | | | - Benjamin A. Schell
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA
| | - Erik Hayman
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA
| | - Clifford Pierre
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | - Jens R. Chapman
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | - Rod J.Oskouian
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
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10
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Zheng B, Abdulrazeq H, Leary OP, Gokaslan ZL, Oyelese AA, Fridley JS, Camara-Quintana JQ. A minimally invasive lateral approach with CT navigation for open biopsy and diagnosis of Nocardia nova L4–5 discitis osteomyelitis: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20164. [PMID: 35854708 PMCID: PMC9241254 DOI: 10.3171/case20164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUNDLumbar spine osteomyelitis can be refractory to conventional techniques for identifying a causal organism. In cases in which a protracted antibiotic regimen is indicated, obtaining a conclusive yield on biopsy is particularly important. Although lateral transpsoas approaches and intraoperative computed tomography (CT) navigation are well documented as techniques used for spinal arthrodesis, their utility in vertebral biopsy has yet to be reported in any capacity.OBSERVATIONSIn a 44-year-old male patient with a history of Nocardia bacteremia, CT-guided biopsy failed to confirm the microbiology of an L4–5 discitis osteomyelitis. The patient underwent a minimally invasive open biopsy in which a lateral approach with intraoperative guidance was used to access the infected disc space retroperitoneally. A thin film was obtained and cultured Nocardia nova, and the patient was treated accordingly with a long course of trimethoprim-sulfamethoxazole.LESSONSThe combination of a lateral transpsoas approach with intraoperative navigation is a valuable technique for obtaining positive yield in cases of discitis osteomyelitis of the lumbar spine refractory to CT-guided biopsy.
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Affiliation(s)
- Bryan Zheng
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hael Abdulrazeq
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen P. Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jared S. Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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11
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Manzur MK, Steinhaus ME, Virk SS, Jivanelli B, Vaishnav AS, McAnany SJ, Albert TJ, Iyer S, Gang CH, Qureshi SA. Fusion rate for stand-alone lateral lumbar interbody fusion: a systematic review. Spine J 2020; 20:1816-1825. [PMID: 32535072 DOI: 10.1016/j.spinee.2020.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral lumbar interbody fusion (LLIF) is used to treat multiple conditions, including spondylolisthesis, degenerative disc disorders, adjacent segment disease, and degenerative scoliosis. Although many advocate for posterior fixation with LLIF, stand-alone LLIF is increasingly being performed. Yet the fusion rate for stand-alone LLIF is unknown. PURPOSE Determine the fusion rate for stand-alone LLIF. STUDY DESIGN Systematic review. METHODS We queried Cochrane, EMBASE, and MEDLINE for literature on stand-alone LLIF fusion rate with a publication cutoff of April 2020. LLIF surgery was considered stand-alone when not paired with supplemental posterior fixation. Cohort fusion rate differences were calculated and tested for significance (p<0.05). All reported means were pooled. RESULTS A total of 2,735 publications were assessed. Twenty-two studies met inclusion criteria, including 736 patients and 1,103 vertebral levels. Mean age was 61.7 years with BMI 26.5 kg/m2. Mean fusion rate was 85.6% (range, 53.0%-100.0%), which did not differ significantly by number of levels fused (1-level, 2-level, and ≥3-level). Use of rhBMP-2 was reported in 39.3% of subjects, with no difference in fusion rates between studies using rhBMP-2 (87.7%) and those in which rhBMP-2 was not used (83.9%, odds ratio=1.37, p=0.448). Fusion rate did not differ with the addition of a lateral plate, or by underlying diagnosis. All-complication rate was 42.2% and mean reoperation rate was 11.1%, with 2.3% reoperation due to pseudarthrosis. Of the studies comparing stand-alone to circumferential fusion, pooled fusion rate was found to be 80.4% versus 91.0% (p=0.637). CONCLUSIONS Stand-alone LLIF yields high fusion rates overall. The wide range of reported fusion rates and lower fusion rates in studies involving subsequent surgical reoperation highlights the importance of proper training in this technique and employing a rigorous algorithm when indicating patients for stand-alone LLIF. Future research should focus on examining risk factors and patient-reported outcomes in stand-alone LLIF.
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Affiliation(s)
- Mustfa K Manzur
- Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA
| | | | - Sohrab S Virk
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Bridget Jivanelli
- The Kim Barrett Memorial Library, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Steven J McAnany
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Todd J Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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12
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Epstein NE. Incidence of Major Vascular Injuries with Extreme Lateral Interbody Fusion (XLIF). Surg Neurol Int 2020; 11:70. [PMID: 32363065 PMCID: PMC7193196 DOI: 10.25259/sni_113_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Extreme lateral interbody fusions (XLIF) and minimally invasive (MI) XLIF theoretically offer wide access to the lumbar disc space. The theoretical advantages of XLIF include; minimally disturbing surrounding structures (e.g. neural, vascular, soft-tissue), while offering stability. In addition to the well-known increased frequency of neurological deficits attributed to XLIF, here we explored how often major vascular injures occur with XLIF/MI XLIF procedures. Methods: In 13 XLIF/MI XLIF studies, we evaluated the frequency of major vascular injuries. Results: The studies citing the different frequencies of vascular injuries associated with XLIF/MI XLIF were broken down into three categories. Of the 5 small and larger case series, involving a total of 6,732 patients (e.g. range of 12 to 4,607 patients/study), the incidence of vascular injuries ranged from 0% (3 studies) up to 0.4%. Three case reports presented major vascular injuries attributed to XLIF/MI XLIF. Two involved the L4-L5 level. The three complications included: one fatal injury, one, a retroperitoneal hematoma with hemorrhagic shock, and one major vascular injury. For the 5 review articles, major vascular complications were just discussed in 2, one study cited 3 specific major vascular injuries (e.g. 1 fatal, 1 life threating, and 1 lumbar artery pseudoaneurysm requiring embolization), while 2 other studies stated the frequency of these injuries was 0.4% for XLIF, and 1.7 % for OLIF (Oblique Lumbar Interbody Fusion). Conclusions: According to 5 small and larger case series, 3 case reports, and 5 review articles, the incidence of major vascular injuries occurring during XLIF/MI XLIF ranges from 0 to 0.03% to 0.4%.
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Affiliation(s)
- Nancy E Epstein
- Adjunct Clinical Professor of Neurological Surgery School of Medicine State University of N.Y. at Stony Brook
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13
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Laratta JL, Weegens R, Malone KT, Chou D, Smith WD. Minimally invasive lateral approaches for the treatment of spinal tumors: single-position surgery without the "flip". JOURNAL OF SPINE SURGERY 2020; 6:62-71. [PMID: 32309646 DOI: 10.21037/jss.2019.12.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although primary tumors of the spine and neural elements are rare, metastatic disease to the spine is quite common. Traditionally, surgical treatment for spinal tumor patients involves open decompression with or without stabilization. The single-position minimally invasive (MIS) lateral approach, which has been recently described over the recent decade, allows simultaneous access to the anterior and posterior columns with the patient positioned in the lateral decubitus position. Herein, we review the application of single-position MIS lateral surgery for the treatment of spinal neoplasm. The aim was to review the evolution, operative technique, outcomes, and complications associated with MIS lateral approaches for spinal tumors. The history of spinal tumor diagnosis and management are reviewed and discussed as well as the author's experience and literature regarding spinal tumor treatment outcome and surgical complications, with particular attention to single-position, MIS lateral approaches. In addition, the author's surgical technique is outlined in detail for thoracic, thoracolumbar and lumbar tumors. Furthermore, there are specific indications and complications associated with the surgical treatment of spinal tumors, and the MIS, single-position lateral approach, when applied appropriately, allows for concurrent access to the anterior and posterior column while mitigating the complications associated with traditional, open posterior-based approaches. In the treatment of spinal neoplasms, the goals of surgery are dictated by a number of tumor-specific and patient-specific factors. Therefore, operative treatment of tumors in the future may be a consolidation of historical surgical techniques and MIS, single-position lateral approaches. Regardless, multidisciplinary management is imperative for the individualized treatment of the patient and optimization of outcome.
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Affiliation(s)
- Joseph L Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Ryan Weegens
- University of Louisville Medical Center, Louisville, KY, USA
| | - Kyle T Malone
- Clinical Resources, NuVasive, Inc., San Diego, CA, USA
| | - Dean Chou
- University of California San Francisco, San Francisco, CA, USA
| | - William D Smith
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA.,University Medical Center of Southern Nevada, Las Vegas, NV, USA
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14
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Kolb B, Peterson C, Fadel H, Yilmaz E, Waife K, Tubbs RS, Rajah G, Walker B, Diaz V, Moisi M. The 25 most cited articles on lateral lumbar interbody fusion: short review. Neurosurg Rev 2020; 44:309-315. [PMID: 31974822 DOI: 10.1007/s10143-020-01243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
The lateral lumbar interbody fusion technique for lumbar arthrodesis is gaining popularity and being added as an option to traditional posterior and anterior approaches. In light of this, we analyzed the literature to identify the 25 most cited articles regarding lateral lumbar interbody fusion. The Thomson Reuters Web of Science was systematically searched to identify papers pertaining to lateral lumbar interbody fusion. The results were sorted in order to identify the top cited 25 articles. Statistical analysis was applied to determine metrics of interest, and observational studies were further classified. A search of all databases in the Thomson Reuters Web of Science identified 379 articles pertaining to lateral lumbar interbody fusion, with a total of 3800 citations. Of the 25 most cited articles, all were case series, reporting on a total of 2981 patients. These 25 articles were cited 2232 times in the literature and total citations per article ranged from 29 to 433. The oldest article was published in 2006, whereas the most recent article was published in 2015. The most cited article, by Ozgar et al., was cited 433 times, and the journal Spine published 7 of the 25 most cited articles. Herein, we report and analyze the 25 most cited articles on lateral lumbar interbody fusion, which include 25 cases series reporting a variety of data on a total of 2513 patients. Such data might assist in the design and interpretation of future studies pertaining to this topic.
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Affiliation(s)
- Bradley Kolb
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - Catherine Peterson
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA.
| | - Hassan Fadel
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - Emre Yilmaz
- Swedish Medical Center, Swedish Neuroscience Institute, 550 17th Ave., Suite 500, Seattle, WA, 98122, USA
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kwame Waife
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - R Shane Tubbs
- Swedish Medical Center, Swedish Neuroscience Institute, 550 17th Ave., Suite 500, Seattle, WA, 98122, USA
| | - Gary Rajah
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - Blake Walker
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - Vicki Diaz
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
| | - Marc Moisi
- Department of Neurosurgery, Detroit Medical Center, 4201 St. Antoine Suite 6E, Detroit, MI, 48201, USA
- Seattle Science Foundation, 550 17th Ave, Seattle, WA, 98122, USA
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15
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Xu S, Liow MHL, Goh KMJ, Yeo W, Ling ZM, Soh CCR, Tan SB, Chen LTJ, Guo CM. Perioperative Factors Influencing Postoperative Satisfaction After Lateral Access Surgery for Degenerative Lumbar Spondylolisthesis. Int J Spine Surg 2019; 13:415-422. [PMID: 31741830 PMCID: PMC6833959 DOI: 10.14444/6056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Lateral access surgery (LAS) for lumbar degenerative spondylolisthesis is a minimally invasive lumbar fusion technique which has been gaining increasing popularity in the recent years. This study aims to identify perioperative factors that influence postoperative satisfaction after LAS for lumbar degenerative spondylolisthesis. METHODS From August 2010 to November 2014, 52 patients with lumbar degenerative conditions (16 male: 36 female, mean age 64.0 ± 8.7 years) were prospectively recruited and underwent LAS by a single surgeon. All patients were assessed preoperatively and 2 years postoperatively with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, Short-Form 36 (SF-36) scores, North American Spine Society score for neurogenic symptoms, patient satisfaction, and expectation fulfillment. Cobb angles, global lumbar lordosis, disc heights, adjacent disc heights, fusion, and subsidence were rates assessed. Multiple linear regression performed with satisfaction as dependent variable to identify predictive independent variables. RESULTS Lower preoperative SF-36 general health scores (P = .03), higher NPRS leg pain scores (P = .04), and longer surgical duration (P = .02) were significant predictors of lower satisfaction (P < .05). NPRS back and leg pain decreased by 80.3 and 83.0%, respectively. Oswestry Disability Index and North American Spine Society score for neurogenic symptoms improved by 76.2 and 75.9%, respectively. Ninety percent of patients reported excellent/good satisfaction. Significant correction and maintenance of Cobb and global lumbar lordosis angles were achieved. There was significant increase in disc heights postoperatively (P = .05) and no significant difference in adjacent disc heights at 2 years (P > .05). Ninety-eight percent of patients achieved Bridwell Fusion Grade 1, and 5.8% had Marchi Grade 3 subsidence. CONCLUSIONS Lower preoperative SF-36 general health, higher NPRS leg pain, and longer surgical duration are predictors of lower satisfaction in patients undergoing LAS for lumbar degenerative spondylolisthesis. LEVEL OF EVIDENCE III. CLINICAL RELEVANCE Identifying preoperative predictors for postoperative clinical outcome can assist clinicians in patient education prior to operation.
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Affiliation(s)
- Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Keng Meng Jeremy Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Zhixing Marcus Ling
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Chee Cheong Reuben Soh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Seang Beng Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Li Tat John Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
| | - Chang Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore
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16
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Smith C, Lamba N, Ou Z, Vo QA, Araujo-Lama L, Lim S, Joshi D, Doucette J, Papatheodorou S, Tafel I, Aglio LS, Smith TR, Mekary RA, Zaidi H. The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis. JOURNAL OF SPINE SURGERY 2019; 5:223-235. [PMID: 31380476 DOI: 10.21037/jss.2019.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The prevalence of spinal deformities increases with age, affecting between 30% and 68% of the elderly population (ages ≥65). The reported prevalence of complications associated with surgery for spinal deformities in this population ranges between 37% and 71%. Given the wide range of reported complication rates, the decision to perform surgery remains controversial. Methods A comprehensive search was conducted using PubMed, Embase, and Cochrane to identify studies reporting complications for spinal deformity surgery in the elderly population. Pooled prevalence estimates for individual complication types were calculated using the random-effects model. Results Of 5,586 articles, 14 met inclusion criteria. Fourteen complication types were reported, with at least 2 studies for each complication with the following pooled prevalence: reoperation (prevalence 19%; 95% CI, 9-36%; 107 patients); hardware failure (11%; 95% CI, 5-25%; 52 patients); infection (7%; 95% CI, 4-12%; 262 patients); pseudarthrosis (6%; 95% CI, 3-12%; 149 patients); radiculopathy (6%; 95% CI, 1-33%; 116 patients); cardiovascular event (5%; 95% CI, 1-32%; 121 patients); neurological deficit (5%; 95% CI, 2-15%; 248 patients); deep vein thrombosis (3%; 95% CI, 1-7%; 230 patients); pulmonary embolism (3%; 95% CI, 1-7%; 210 patients); pneumonia (3%; 95% CI, 1-11%; 210 patients); cerebrovascular or stroke event (2%; 95% CI, 0-9%; 85 patients); death (2%; 95% CI, 1-9%; 113 patients); myocardial infarction (2%; 95% CI, 1-6%; 210 patients); and postoperative hemorrhage (1%; 95% CI, 0-10%; 85 patients). Conclusions Most complication types following spinal deformity surgery in the elderly had prevalence point estimates of <6%, while all were at least ≤19%. Additional studies are needed to further explore composite prevalence estimates and prevalence associated with traditional surgical approaches as compared to minimally-invasive procedures in the elderly.
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Affiliation(s)
- Colleen Smith
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhonghui Ou
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Quynh-Anh Vo
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Lita Araujo-Lama
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Sanghee Lim
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Dhaivat Joshi
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | | | - Ian Tafel
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA.,Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hasan Zaidi
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Smith C, Lamba N, Ou Z, Vo QA, Araujo-Lama L, Lim S, Joshi D, Doucette J, Papatheodorou S, Tafel I, Aglio LS, Smith TR, Mekary RA, Zaidi H. The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis. JOURNAL OF SPINE SURGERY (HONG KONG) 2019. [PMID: 31380476 DOI: 10.21037/jss.2019.03.06.pmid:31380476;pmcid:pmc6626743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The prevalence of spinal deformities increases with age, affecting between 30% and 68% of the elderly population (ages ≥65). The reported prevalence of complications associated with surgery for spinal deformities in this population ranges between 37% and 71%. Given the wide range of reported complication rates, the decision to perform surgery remains controversial. METHODS A comprehensive search was conducted using PubMed, Embase, and Cochrane to identify studies reporting complications for spinal deformity surgery in the elderly population. Pooled prevalence estimates for individual complication types were calculated using the random-effects model. RESULTS Of 5,586 articles, 14 met inclusion criteria. Fourteen complication types were reported, with at least 2 studies for each complication with the following pooled prevalence: reoperation (prevalence 19%; 95% CI, 9-36%; 107 patients); hardware failure (11%; 95% CI, 5-25%; 52 patients); infection (7%; 95% CI, 4-12%; 262 patients); pseudarthrosis (6%; 95% CI, 3-12%; 149 patients); radiculopathy (6%; 95% CI, 1-33%; 116 patients); cardiovascular event (5%; 95% CI, 1-32%; 121 patients); neurological deficit (5%; 95% CI, 2-15%; 248 patients); deep vein thrombosis (3%; 95% CI, 1-7%; 230 patients); pulmonary embolism (3%; 95% CI, 1-7%; 210 patients); pneumonia (3%; 95% CI, 1-11%; 210 patients); cerebrovascular or stroke event (2%; 95% CI, 0-9%; 85 patients); death (2%; 95% CI, 1-9%; 113 patients); myocardial infarction (2%; 95% CI, 1-6%; 210 patients); and postoperative hemorrhage (1%; 95% CI, 0-10%; 85 patients). CONCLUSIONS Most complication types following spinal deformity surgery in the elderly had prevalence point estimates of <6%, while all were at least ≤19%. Additional studies are needed to further explore composite prevalence estimates and prevalence associated with traditional surgical approaches as compared to minimally-invasive procedures in the elderly.
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Affiliation(s)
- Colleen Smith
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhonghui Ou
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Quynh-Anh Vo
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Lita Araujo-Lama
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Sanghee Lim
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Dhaivat Joshi
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | - Joanne Doucette
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA
| | | | - Ian Tafel
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA.,Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hasan Zaidi
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Cage Subsidence and Fusion Rate in Extreme Lateral Interbody Fusion with and without Fixation. World Neurosurg 2019; 122:e969-e977. [DOI: 10.1016/j.wneu.2018.10.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 11/19/2022]
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19
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Xiao L, Xu Z, Liu C, Zhao Q, Zhang Y, Xu H. Anatomic Relationship Between Ureter and Oblique Lateral Interbody Fusion Access: Analysis Based on Contrast-Enhanced Computed Tomographic Urography. World Neurosurg 2018; 123:e717-e722. [PMID: 30576813 DOI: 10.1016/j.wneu.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the anatomic relationship between ureter and oblique lateral interbody fusion access by using contrast-enhanced computed tomographic urography. METHODS Contrast-enhanced computed tomographic urography data of 234 patients were retrospectively analyzed. The angle of inclination (∠α) of bilateral ureters, the angle between bilateral surgical accesses (∠β), the insertion angle of surgical access (∠γ), and the angle between ureter and outer margin of ipsilateral surgical access (∠ε) at L2/3, L3/4, and L4/5 levels were measured and analyzed. RESULTS ∠α gradually increased from L2/3 to L4/5. ∠β gradually decreased from L2/3 to L4/5, and at each level the left-sided ∠β was larger than right-sided ∠β. ∠ε were positive at L2/3 and left-sided L3/4. The right-sided ∠ε at L3/4 and the bilateral sided ∠ε at L4/5 were negative, and the right-sided ∠ε at L4/5 had the largest absolute value. CONCLUSIONS The bilateral ureters gradually descents from the lateral margin to the anteromedial margin on the surface of psoas major muscle. The range of bilateral surgical accesses for oblique lateral interbody fusion gradually decreases from L2/3 to L4/5, and the left-sided access is larger than the right-sided when at the same level. Ureters at the right-sided L3/4 level and bilateral L4/5 levels are at high risk of being injured. In particular, the right ureter at the L4/5 level is most likely to be injured.
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Affiliation(s)
- Liang Xiao
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Ziang Xu
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Chen Liu
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Quanlai Zhao
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Yu Zhang
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Hongguang Xu
- Research Center of Spine Surgery, Department of Orthopedic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China.
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20
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Agarwal N, Faramand A, Alan N, Tempel ZJ, Hamilton DK, Okonkwo DO, Kanter AS. Lateral lumbar interbody fusion in the elderly: a 10-year experience. J Neurosurg Spine 2018; 29:525-529. [PMID: 30052150 DOI: 10.3171/2018.3.spine171147] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/14/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEElderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications following spine surgery. Various minimally invasive surgical techniques have been developed and employed to treat an array of spinal conditions while minimizing complications. Lateral lumbar interbody fusion (LLIF) is one such approach. The authors describe clinical outcomes in patients over the age of 70 years following stand-alone LLIF.METHODSA retrospective query of a prospectively maintained database was performed for patients over the age of 70 years who underwent stand-alone LLIF. Patients with posterior segmental fixation and/or fusion were excluded. The preoperative and postoperative values for the Oswestry Disability Index (ODI) were analyzed to compare outcomes after intervention. Femoral neck t-scores were acquired from bone density scans and correlated with the incidence of graft subsidence.RESULTSAmong the study cohort of 55 patients, the median age at the time of surgery was 74 years (range 70-87 years). Seventeen patients had at least 3 medical comorbidities at surgery. Twenty-three patients underwent a 1-level, 14 a 2-level, and 18 patients a 3-level or greater stand-alone lateral fusion. The median estimated blood loss was 25 ml (range 5-280 ml). No statistically significant relationship was detected between volume of blood loss and the number of operative levels. The median length of hospital stay was 2 days (range 1-4 days). No statistically significant relationship was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.8%. One patient developed a transient femoral nerve injury. Five patients with symptomatic graft subsidence subsequently underwent posterior instrumentation. A lower femoral neck t-score < -1.0 correlated with a higher incidence of graft subsidence (p = 0.006). The mean ODI score 1 year postoperatively of 31.1 was significantly (p = 0.003) less than the mean preoperative ODI score of 46.2.CONCLUSIONSStand-alone LLIF can be safely and effectively performed in the elderly population. Careful evaluation of preoperative bone density parameters should be employed to minimize risk of subsidence and need for additional surgery. Despite an association with increased comorbidities, age alone should not be a deterrent when considering stand-alone LLIF in the elderly population.
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21
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Accuracy of the lateral cage placement under intraoperative C-arm fluoroscopy in oblique lateral interbody fusion. J Orthop Sci 2018; 23:918-922. [PMID: 30119930 DOI: 10.1016/j.jos.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/28/2018] [Accepted: 07/14/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND In oblique lateral interbody fusion (OLIF), the lateral cage enters into the disc space obliquely, and is then turned to the true lateral direction to achieve a lateral lumbar interbody fusion. The OLIF cage is sometimes placed asymmetrically although it seemed to be placed accurately on intraoperative C-arm images. The present study aimed to investigate the accuracy of cage placement and its effect on the radiological outcome in OLIF. METHODS This study involved a retrospective radiological analysis of 127 lateral cages in 75 consecutive OLIF patients. The cage deviations from the midline and cage obliquity were evaluated using three sets of images: (1) intraoperative C-arm fluoroscopy, (2) postoperative standing radiographs, and (3) postoperative computed tomography (CT). RESULTS The mean cage deviation from the midline was measured as 2.5 ± 2.7 mm on intraoperative C-arm images, but was found to be more deviated on postoperative radiographs and CT (5.4 ± 3.8 mm and 3.8 ± 3.7 mm; P = 0.000 and 0.005, respectively). The cage obliquity on the intraoperative lateral C-arm was minimal in 26 (20.5%) cases, mild in 69 (54.3%), and moderate in 32 (25.2%), but was found to be more obliquely on postoperative radiographs as minimal in 9 (7.1%), mild in 55 (43.3%), and moderate in 63 (49.6%) (P < 0.001). Anterior/posterior disc heights, disc lordotic angle, fusion rate, and cage subsidence rate were not different according to cage obliquity (all P > 0.05). CONCLUSIONS Cage deviation from the midline and obliquity is underestimated on intraoperative C-arm images in OLIF. Although minimal cage deviation and obliquity did not affect the radiological outcome, great care should be made for the orthogonal cage insertion.
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Abstract
For patients with significant spinal deformity, the pedicle subtraction osteotomy provides a powerful means for correction, albeit with high morbidity. With the trend toward minimally invasive spine surgery, multiple less invasive techniques have been devised; however, there seems to be an upper limit to the degree of correction possible. The mini-open pedicle subtraction osteotomy addresses these limitations by minimizing the extent of soft tissue destruction needed to perform the osteotomy and by using the rod-cantilever technique to achieve maximum lordosis. Preliminary data are promising, with significant improvements in patient-reported clinical outcome measures as well as coronal and sagittal alignment.
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Affiliation(s)
- Andrew A Fanous
- Department of Neurological Surgery, University of Miami, 1095 Northwest 14th Terrace, Miami, FL 33136, USA
| | - Jason I Liounakos
- Department of Neurological Surgery, University of Miami, 1095 Northwest 14th Terrace, Miami, FL 33136, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, 1095 Northwest 14th Terrace, Miami, FL 33136, USA.
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Oyelese AA, Fridley J, Choi DB, Telfeian A, Gokaslan ZL. Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1-2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases. J Neurosurg Spine 2018; 29:46-53. [PMID: 29676674 DOI: 10.3171/2017.11.spine17509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Upper lumbar (L1-2, L2-3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1-2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.
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Derman PB, Albert TJ. Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis. Curr Rev Musculoskelet Med 2017; 10:530-538. [PMID: 29076042 PMCID: PMC5685965 DOI: 10.1007/s12178-017-9443-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The various lumbar interbody fusion (IBF) techniques and the evidence for their use in the treatment of degenerative lumbar spondylolisthesis (DLS) are described in this review. RECENT FINDINGS The existing evidence is mixed regarding the indications for and utility of IBF in DLS, but its use in the setting of pre-operative instability is most strongly supported. Anterior (ALIF), lateral (LLIF), posterior (PLIF), transforaminal (TLIF), and axial (AxiaLIF) lumbar IBF approaches have been described. While the current data are limited, TLIF may be a better option than PLIF in DLS due the increased operative morbidity and peri-operative complications observed with the latter. LLIF also appears superior to PLIF in light of improved radiologic outcomes, fewer intra-operative complications, and potentially greater improvements in disability. The data comparing LLIF to TLIF are less conclusive. No studies specifically comparing ALIF or AxiaLIF to other IBF techniques could be identified. Instability may be the strongest indication for IBF in DLS. When IBF is employed, the authors' preferred technique is TLIF with posterior segmental spinal instrumentation. Further research is needed.
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Affiliation(s)
- Peter B Derman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, 60612, USA
| | - Todd J Albert
- Hospital for Special Surgery, 535 East 71st St., New York, NY, 10021, USA.
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Narain AS, Hijji FY, Markowitz JS, Kudaravalli KT, Yom KH, Singh K. Minimally invasive techniques for lumbar decompressions and fusions. Curr Rev Musculoskelet Med 2017; 10:559-566. [PMID: 29027622 DOI: 10.1007/s12178-017-9446-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to summarize the recent literature investigating the use of minimally invasive (MIS) techniques in the treatment of lumbar degenerative stenosis, spondylolisthesis, and scoliosis. RECENT FINDINGS MIS lumbar decompression and fusion techniques for degenerative pathology are associated with reduced operative morbidity, shortened length of hospital stay, and reduced postoperative pain and narcotics utilization. Recent studies with long-term clinical follow-up have demonstrated equivalence in clinical outcomes between open and MIS surgical procedures. Radiographically, MIS procedures provide adequate postoperative correction of coronal alignment. Correction of sagittal alignment, however, is more variable based on current reports. MIS techniques are both safe and effective in the treatment of lumbar degenerative pathologies. While some studies have reported on long-term outcomes and costs associated with MIS procedures, more investigation into these topics is still necessary. Additionally, further work is required to analyze the training requirements and learning curves of MIS procedures to better promote adoption amongst surgeons.
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Affiliation(s)
- Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Jonathan S Markowitz
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Krishna T Kudaravalli
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kelly H Yom
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Kim C, Harris JA, Muzumdar A, Khalil S, Sclafani JA, Raiszadeh K, Bucklen BS. The effect of anterior longitudinal ligament resection on lordosis correction during minimally invasive lateral lumbar interbody fusion: Biomechanical and radiographic feasibility of an integrated spacer/plate interbody reconstruction device. Clin Biomech (Bristol, Avon) 2017; 43:102-108. [PMID: 28235698 DOI: 10.1016/j.clinbiomech.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral lumbar interbody fusion is powerful for correcting degenerative conditions, yet sagittal correction remains limited by anterior longitudinal ligament tethering. Although lordosis has been restored via ligament release, biomechanical consequences remain unknown. Investigators examined radiographic and biomechanical of ligament release for restoration of lumbar lordosis. METHODS Six fresh-frozen human cadaveric spines (L3-S1) were tested: (Miller et al., 1988) intact; (Battie et al., 1995) 8mm spacer with intact anterior longitudinal ligament; (Cho et al., 2013) 8mm spacer without intact ligament following ligament resection; (Galbusera et al., 2013) 13mm lateral lumbar interbody fusion; (Goldstein et al., 2001) integrated 13mm spacer. Focal lordosis and range of motion were assessed by applying pure moments in flexion-extension, lateral bending, and axial rotation. FINDINGS Cadaveric radiographs showed significant improvement in lordosis correction following ligament resection (P<0.05). The 8mm spacer with ligament construct provided greatest stability relative to intact (P>0.05) but did little to restore lordosis. Ligament release significantly destabilized the spine relative to intact in all modes and 8mm with ligament in lateral bending and axial rotation (P<0.05). Integrated lateral lumbar interbody fusion following ligament resection did not significantly differ from intact or from 8mm with ligament in all testing modes (P>0.05). INTERPRETATION Lordosis corrected by lateral lumbar interbody fusion can be improved by anterior longitudinal ligament resection, but significant construct instability and potential implant migration/dislodgment may result. This study shows that an added integrated lateral fixation system can significantly improve construct stability. Long-term multicenter studies are needed.
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Affiliation(s)
- Choll Kim
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Aditya Muzumdar
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Saif Khalil
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
| | - Joseph A Sclafani
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Kamshad Raiszadeh
- Spine Institute of San Diego, 6719 Alvarado Road, Suite 308, San Diego, CA 92120, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA.
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Malham GM, Parker RM. Treatment of symptomatic thoracic disc herniations with lateral interbody fusion. JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 1:86-93. [PMID: 27683683 DOI: 10.3978/j.issn.2414-469x.2015.10.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. METHODS This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. RESULTS Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. CONCLUSIONS LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation.
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Affiliation(s)
- Gregory M Malham
- Neuroscience Institute, Epworth Hospital, Melbourne, Victoria 3121, Australia
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Phan K, Huo YR, Hogan JA, Xu J, Dunn A, Cho SK, Mobbs RJ, McKenna P, Rajagopal T, Altaf F. Minimally invasive surgery in adult degenerative scoliosis: a systematic review and meta-analysis of decompression, anterior/lateral and posterior lumbar approaches. JOURNAL OF SPINE SURGERY 2016; 2:89-104. [PMID: 27683705 DOI: 10.21037/jss.2016.06.07] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive approaches for the treatment of adult degenerative scoliosis have been increasingly implemented. However, little data exists regarding the safety and complication profiles of minimally invasive lumbar interbody fusion (LIF) for adult degenerative scoliosis. This study aimed to greater understand different minimally invasive surgical approaches for adult degenerative scoliosis with respect to clinical outcomes, changes in radiographic measurements, and complication profiles via meta-analytical techniques. METHODS A systematic search of six databases from inception to September 2015 was performed by two independent reviewers. Relevant studies were those that described the safety and/or effectiveness of minimally invasive anterior or lateral LIF (LLIF), transforaminal LIF (TLIF), and decompression only. Meta-analytical techniques and meta-regression were used to pool overall rates, and compare the different techniques. There was no financial funding or conflict of interest. RESULTS A total of 29 studies (1,228 patients) were included in this meta-analysis. Total pooled fusion rate was 95.9% (95% CI: 92.7-98.2%) for the anterior/lateral approach. The pooled construct or hardware-related complications was 4.3%, and was similar among anterior/lateral (4.4%) and posterior (5.2%) techniques. The total pooled pseudoarthrosis rate was 4.3% for the lateral approach. The overall pooled rate of motor deficit was 2.7% (95% CI: 1.7-4.0%). Subgroup meta-regression demonstrated that the anterior/lateral approach had the highest rate of motor deficits (3.6% LLIF vs. 0.7% TLIF vs. 0.5% decompression, P=0.004). The overall pooled rate of sensory deficit was 2.4%, highest for the anterior/lateral technique (3.3%) compared to TLIF (0.7%) and decompression (0.5%). The infection rate, dural tears/CSF leak, cardiac and pulmonary events were similar among the techniques, with a pooled value of 2.6%, 3.9%, 1.7%, and 1.4%, respectively. Similarly satisfactory radiological outcomes were obtained amongst the different approaches. CONCLUSIONS Minimally invasive spine technologies may be used for the surgical treatment of lumbar degenerative scoliosis with acceptable complication rates, functional and radiological outcome. Future studies, specifically multi-centered longitudinal, examining the adequacy of minimally invasive spine surgery is warranted to compare long-term outcomes with the traditional procedure.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ya Ruth Huo
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Jarred A Hogan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Joshua Xu
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Alexander Dunn
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Samuel K Cho
- Leni & Peter W May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Patrick McKenna
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK
| | - Trichy Rajagopal
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK
| | - Farhaan Altaf
- Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, Australia
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Blizzard DJ, Gallizzi MA, Sheets C, Smith BT, Isaacs RE, Eure M, Brown CR. Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis. Int J Spine Surg 2016; 10:29. [PMID: 27652200 DOI: 10.14444/3029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population. The objective of this study is to evaluate the ability of LIF to restore sagittal balance in degenerative lumbar scoliosis. METHODS Thirty-five patients who underwent LIF for degenerative thoracolumbar scoliosis from July 2013 to March 2014 by a single surgeon were included. Outcome measures included sagittal balance, lumbar lordosis, Cobb Angle, and segmental lordosis. Measures were evaluated pre-operative, immediately post-operatively, and at their last clinical follow-up. Repeated measures ANOVAs were used to assess the differences between pre-operative, first postoperative, and a follow-up visit. RESULTS The average sagittal balance correction was not significantly different: 1.06cm from 5.79cm to 4.74cm forward. The average Cobb angle correction was 14.1 degrees from 21.6 to 5.5 degrees. The average change in global lumbar lordosis was found to be significantly different: 6.3 degrees from 28.9 to 35.2 degrees. CONCLUSIONS This study demonstrates that LIF reliably restores lordosis, but does not significantly improve sagittal balance. Despite this, patients had reliable improvement in pain and functionality suggesting that sagittal balance correction may not be as critical in scoliosis correction as previous studies have indicated. CLINICAL RELEVANCE LIF does not significantly change sagittal balance; however, clinical improvement does not seem to be contingent upon sagittal balance correction in the degenerative scoliosis population. The DUHS IRB has determined this study meets criteria for an IRB waiver.
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Affiliation(s)
- Daniel J Blizzard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Michael A Gallizzi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles Sheets
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Benjamin T Smith
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Robert E Isaacs
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Megan Eure
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher R Brown
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Plata-Bello J, Roldan H, Brage L, Rahy A, Garcia-Marin V. Delayed Abdominal Pseudohernia in Young Patient After Lateral Lumbar Interbody Fusion Procedure: Case Report. World Neurosurg 2016; 91:671.e13-6. [DOI: 10.1016/j.wneu.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022]
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Surgical Incision and Approach in Thoracolumbar Extreme Lateral Interbody Fusion Surgery: An Anatomic Study of the Diaphragmatic Attachments. Spine (Phila Pa 1976) 2016; 41:E186-90. [PMID: 26352744 DOI: 10.1097/brs.0000000000001183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric study. OBJECTIVE To provide anatomical basis for deciding the surgical approach and skin incision in thoracolumbar extreme lateral interbody fusion (XLIF) by delineating the attachment points of diaphragm. SUMMARY OF BACKGROUND DATA Although the general anatomy of the thoracic diaphragm is well described, the specific attachment points of diaphragm concerned with the XLIF approach is yet to be elaborated. METHODS Dissections were performed on 21 cases of formalin fixed specimens (12 males, 9 females, a total of 42 sets of data). Special attention was paid to the attachment points of diaphragm on both sides at the midaxillary line (MAL point) and the vertebral level parallel to the MAL point (VL-MAL). The attachment points of diaphragm on the front and back edge of the spinal column (FES point and BES point) were also described. RESULTS The MAL point of diaphragm muscle lied between the inferior edge of the 10th rib and the superior edge of the 12th rib (20 out of 21 on left, 21 out of 21 on right). VL-MAL lied between L1 and L2 vertebrae level (20 out of 21 on left, 18 out of 21 on right). The attachments on both sides of the vertebral column mainly located between the upper edge of T12 vertebrae and L1-L2 disc (38 out of 42). CONCLUSION A transthoracic approach should be considered when the target level was above T12 vertebrae, whereas a retroperitoneal approach should be chosen when target level was below L1-L2 disc. If the target level is located between T12 and L1-L2 disc, whether via transthoracic, retropleural, or retroperitoneal approach should be determined according to the conditions of patients and the skill and experience of the surgeon. Incision should be made above the 10th rib for the transthoracic approach and below the 12th rib for the retroperitoneal approach. LEVEL OF EVIDENCE 4.
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Mattei TA. Right L4/L5 Extreme-Lateral Interbody Fusion for Adult Degenerative Scoliosis: When the Black Swan Is Too Real…. World Neurosurg 2015; 84:1500-5. [DOI: 10.1016/j.wneu.2015.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Li X, Zhang J, Tang H, Lu Z, Liu S, Chen S, Hong Y. Comparison Between Posterior Short-segment Instrumentation Combined With Lateral-approach Interbody Fusion and Traditional Wide-open Anterior-Posterior Surgery for the Treatment of Thoracolumbar Fractures. Medicine (Baltimore) 2015; 94:e1946. [PMID: 26554800 PMCID: PMC4915901 DOI: 10.1097/md.0000000000001946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to compare the radiographic and clinical outcomes between posterior short-segment pedicle instrumentation combined with lateral-approach interbody fusion and traditional anterior-posterior (AP) surgery for the treatment of thoracolumbar fractures.Lateral-approach interbody fusion has achieved satisfactory results for thoracic and lumbar degenerative disease. However, few studies have focused on the use of this technique for the treatment of thoracolumbar fractures.Inclusion and exclusion criteria were established. All patients who meet the above criteria were prospectively treated by posterior short-segment instrumentation and secondary-staged minimally invasive lateral-approach interbody fusion, and classified as group A. A historical group of patients who were treated by traditional wide-open AP approach was used as a control group and classified as group B. The radiological and clinical outcomes were compared between the 2 groups.There were 12 patients in group A and 18 patients in group B. The mean operative time and intraoperative blood loss of anterior reconstruction were significantly higher in group B than those in group A (127.1 ± 21.7 vs 197.5 ± 47.7 min, P < 0.01; 185.8 ± 62.3 vs 495 ± 347.4 mL, P < 0.01). Two of the 12 (16.7%) patients in group A experienced 2 surgical complications: 1 (8.3%) major and 1 (8.3%) minor. Six of the 18 (33%) patients in group B experienced 9 surgical complications: 3 (16.7%) major and 6 (33.3%) minor. There was no significant difference between the 2 groups regarding loss of correction (4.3 ± 2.1 vs 4.2 ± 2.4, P = 0.89) and neurological function at final follow-up (P = 0.77). In both groups, no case of instrumentation failure, pseudarthrosis, or nonunion was noted.Compared with the wide-open AP surgery, posterior short-segment pedicle instrumentation, combined with minimally invasive lateral-approach interbody fusion, can achieve similar clinical results with significant less operative time, blood loss, and surgical complication. This procedure seems to be a reasonable treatment option for selective patients with thoracolumbar fractures.
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Affiliation(s)
- Xiang Li
- From the School of Rehabilitation Medicine, China Capital Medical University (XL, JZ, HT, ZL, SL, SC, YH); and Department of Spine Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China (XL, JZ, HT, ZL, SL, SC, YH)
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Abstract
Lateral approaches to the lumbar disc space have become popular in recent years with very few reported complications. We report on a rare case of a stand-alone cage migration. A 77-year-old female presented with a right L2-3 radiculopathy that was refractory to maximum medical management. This was secondary to foraminal compression at L2-3 and L3-4 due to degenerative disc disease and levoscoliosis, as well as Grade 1 spondylolisthesis at both levels. A left-sided approach lateral lumbar interbody fusion was performed at L2-3 and L3-4 using a lordotic polyetheretherketone (PEEK) graft (50 mm length x 18 mm width x 9 mm height) packed with demineralized bone matrix (DBM). A contralateral release of the annulus fibrosis was performed during the decompression prior to graft insertion. Postoperative anteroposterior and lateral x-ray imaging confirmed good position of interbody grafts, correction of scoliosis as well as spondylolisthesis, and restoration of disc height achieving foraminal indirect decompression. A routine postoperative x-ray at three months demonstrated asymptomatic ipsilateral cage migration at the L2-3 level with evidence of arthrodesis in the disc space. This was managed conservatively without further surgical intervention. Placement of a lateral plate or interbody intradiscal plating system in patients with scoliosis and significant coronal deformity is an option that can be considered to prevent this rare LLIF complication. Moreover, asymptomatic cage migration may be conservatively managed without reoperation.
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Affiliation(s)
- Wendy S Towers
- Neurosurgery, University of Maryland Shore Regional Health
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Cheng I, Briseño MR, Arrigo RT, Bains N, Ravi S, Tran A. Outcomes of Two Different Techniques Using the Lateral Approach for Lumbar Interbody Arthrodesis. Global Spine J 2015; 5. [PMID: 26225280 PMCID: PMC4516734 DOI: 10.1055/s-0035-1546816] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Study Design Retrospective cohort study. Objective To determine the short-term outcomes of two different lateral approaches to the lumbar spine. Methods This was a retrospective review performed with four fellowship-trained spine surgeons from a single institution. Two different approach techniques were identified. (1) Traditional transpsoas (TP) approach: dissection was performed through the psoas performed using neuromonitored sequential dilation. (2) Direct visualization (DV) approach: retractors are placed superficial to the psoas followed by directly visualized dissection through psoas. Outcome measures included radiographic fusion and adverse event (AE) rate. Results In all, 120 patients were identified, 79 women and 41 men. Average age was 64.2 years (22 to 86). When looking at all medical and surgical AEs, 31 patients (25.8%) had one or more AEs; 22 patients (18.3%) had a total of 24 neurologically related AEs; 15 patients (12.5%) had anterior/lateral thigh dysesthesias; 6 patients (5.0%) had radiculopathic pain; and 3 patients (2.5%) had postoperative weakness. Specifically, for neurologic AEs, the DV group had a rate of 28.0% and the TP group had a rate of 14.2% (p < 0.18). When looking at the rate of neurologic AEs in patients undergoing single-level fusions only, the DV group rate was 28.6% versus 10.2% for the TP group (p < 0.03). Conclusion Overall, 18.3% of patients sustained a postoperative neurologic AE following lateral interbody fusions. The TP approach had a statistically lower rate of neurologic-specific AE for single-level fusions.
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Affiliation(s)
- Ivan Cheng
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States,Address for correspondence Ivan Cheng, MD Stanford University Hospital and Clinics450 Broadway Street, MC 6342, Redwood City, CA 94063United States
| | - Michael R. Briseño
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States
| | - Robert T. Arrigo
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States
| | - Navpreet Bains
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States
| | - Shashank Ravi
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States
| | - Andrew Tran
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States
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Patel NB, Dodd ZH, Voorhies J, Horn EM. Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis. J Clin Neurosci 2015. [PMID: 26209920 DOI: 10.1016/j.jocn.2015.03.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more extensive treatment.
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Affiliation(s)
- Neal B Patel
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, USA
| | - Zachary H Dodd
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, USA
| | - Jason Voorhies
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, USA
| | - Eric M Horn
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, USA.
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Phan K, Rao PJ, Scherman DB, Dandie G, Mobbs RJ. Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. J Clin Neurosci 2015; 22:1714-21. [PMID: 26190218 DOI: 10.1016/j.jocn.2015.03.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has been an increasing emphasis on minimally invasive fusion and instrumentation techniques, with the aim of minimizing surgical trauma and blood loss and reducing hospitalization. From six electronic databases, 21 eligible studies were included for review. The pooled weighted average mean of preoperative visual analogue scale (VAS) pain scores was 6.8, compared to a postoperative VAS score of 2.9 (p<0.0001). The weighted average preoperative and postoperative coronal segmental Cobb angles were 3.6 and 1.1°, respectively. The weighted average preoperative and postoperative coronal regional Cobb angles were 19.1 and 10.0°, respectively. Regional lumbar lordosis also significantly improved from 35.8 to 43.3°. Sagittal alignment was comparable pre- and postoperatively (34 mm versus 35.1mm). The weighted average operative duration was 125.6 minutes, whilst the mean estimated blood loss was 155 mL. The weighted average hospitalization length was 3.6 days. Whilst the available data is limited, minimally invasive XLIF procedures appear to be a promising alternative for the treatment of scoliosis, with improved functional VAS and Oswestry disability index outcomes and restored coronal deformity. Future comparative studies are warranted to assess the long term benefits and risks of XLIF compared to anterior and posterior procedures.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Prashanth J Rao
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia
| | | | | | - Ralph J Mobbs
- NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
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MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. 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 2015; 24 Suppl 3:287-313. [DOI: 10.1007/s00586-015-3886-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
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Tempel ZJ, Gandhoke GS, Okonkwo DO, Kanter AS. Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion. 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 2015; 24 Suppl 3:414-9. [PMID: 25739988 DOI: 10.1007/s00586-015-3844-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The LLIF procedure is a useful stand-alone and adjunct surgical approach for many spinal conditions. One complication of LLIF is subsidence of the interbody graft into the vertebral bodies, resulting in severe pain, impaired arthrodesis and potentially fracture of the body. Low bone density, as measured by T score on DEXA scanning, has also been postulated to increase the risk of subsidence. METHODS A retrospective review of prospectively collected data was performed on all patients who underwent LLIF at this institution consisting of 712 levels in 335 patients. Patients with subsidence following LLIF were recorded. We utilized the T score obtained from the femoral neck DEXA scans, which is used to determine overall fracture risk. The T score of patients with subsidence was compared to those without subsidence. RESULTS 20 of 57 (35 %) patients without subsidence had a DEXA T score between -1.0 and -2.4 consistent osteopenia, one patient (1.8 %) exhibited a T score less than -2.5, consistent with osteoporosis. 13 patients of 23 (57 %) with subsidence exhibited a T score between -1.0 and -2.4, consistent with osteopenia, five (22 %) exhibited a T score of -2.5 or less, consistent with osteoporosis. The mean DEXA T score in patients with subsidence was -1.65 (SD 1.04) compared to -0.45 (SD 0.97) in patients without subsidence (p < 0.01). The area under the receiver operating characteristic curve for patients with a T score of -1.0 or less was 80.1 %. CONCLUSIONS Patients with DEXA T scores less than -1.0 who undergo stand-alone LLIF are at a much higher risk of developing graft subsidence. Further, they are at an increased risk of requiring additional surgery. In patients with poor bone quality, consideration could be made to supplement the LLIF cage with posterior instrumentation.
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Affiliation(s)
- Zachary J Tempel
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,
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Dangelmajer S, Zadnik PL, Rodriguez ST, Gokaslan ZL, Sciubba DM. Minimally invasive spine surgery for adult degenerative lumbar scoliosis. Neurosurg Focus 2015; 36:E7. [PMID: 24785489 DOI: 10.3171/2014.3.focus144] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. METHODS In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. RESULTS Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). CONCLUSIONS The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.
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Affiliation(s)
- Sean Dangelmajer
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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[Extreme lateral interbody fusion. Indication, surgical technique, outcomes and specific complications]. DER ORTHOPADE 2015; 44:138-45. [PMID: 25586505 DOI: 10.1007/s00132-014-3070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Extreme lateral interbody fusion (XLIF) is an interbody fusion technique, in which access to the lateral part of the disc is achieved via a strong lateral transpsoatic approach. In general, the technique can be applied between T5 and L5. For lumbar segments, neuromonitoring is mandatory to protect the iliolumbar plexus during the psoas passage. OBJECTIVES In this article, the results regarding use of the XLIF technique are summarized and compared with other anterior and anterolateral approaches. In addition, current publications regarding indication, technique, complications and clinical/radiological outcome measures are discussed. METHODS The results of a literature review are presented and discussed. RESULTS Regarding the indication and the surgical options for segmental restoration, the XLIF technique is comparable to anterior or anterolateral and open lateral interbody fusion. The minimally invasive XLIF access promises potentially lower morbidity than open procedures and the risk of injury of the iliac vessels is lower than in anterior and anterolateral approaches. CONCLUSION Increasing numbers of spine surgeons are using the XLIF method. Current results indicate that XLIF is a safe and reproducible technique for deformities, adjacent level disease, and instability.
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Kim SJ, Lee YS, Kim YB, Park SW, Hung VT. Clinical and radiological outcomes of a new cage for direct lateral lumbar interbody fusion. KOREAN JOURNAL OF SPINE 2014; 11:145-51. [PMID: 25346760 PMCID: PMC4206975 DOI: 10.14245/kjs.2014.11.3.145] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In Korea, direct lateral interbody fusion (DLIF) was started since 2011, using standard cage (6° lordotic angle, 18mm width). Recently, a new wider cage with higher lordotic angle (12°, 22mm) was introduced. The aim of our study is to compare the clinical and radiologic outcomes of the two cage types. METHODS We selected patients underwent DLIF, 125 cases used standard cages (standard group) and 38 cases used new cages (wide group). We followed them up for more than 6 months, and their radiological and clinical outcomes were analyzed retrospectively. For radiologic outcomes, lumbar lordotic angle (LLA), segmental lordoic angle (SLA), disc angle (DA), foraminal height change (FH), subsidence and intraoperative endplate destruction (iED) were checked. Clinical outcomes were compared using visual analog scale (VAS) score, Oswestry disability index (ODI) score and complications. RESULTS LLA and SLA showed no significant changes postoperatively in both groups. DA showed significant increase after surgery in the wide group (p<0.05), but not in the standard group. Subsidence was significantly lower in the wide group (p<0.05). There was no difference in clinical outcomes between the two groups. Additional posterior decompression was done more frequently in the wide group. Postoperative change of foraminal height was significantly lower in the wide group (p<0.05). The iED was observed more frequently in the wide group (p<0.05) especially at the anterior edge of cage. CONCLUSION The new type of cage seems to result in more DA and less subsidence. But indirect foraminal decompression seems to be less effective than standard cage. Intraoperative endplate destruction occurs more frequently due to a steeper lordotic angle of the new cage.
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Affiliation(s)
- Shin Jae Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Vo Tan Hung
- Department of Orthopedic and Trauma, Quang Nam Central General Hospital, Quang Nam, Vietnam
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Palejwala SK, Sheen WA, Walter CM, Dunn JH, Baaj AA. Minimally invasive lateral transpsoas interbody fusion using a stand-alone construct for the treatment of adjacent segment disease of the lumbar spine: review of the literature and report of three cases. Clin Neurol Neurosurg 2014; 124:90-6. [PMID: 25019458 DOI: 10.1016/j.clineuro.2014.06.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/08/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
We describe 3 patients who presented with radiographic signs and clinical symptoms of adjacent segment disease several years after undergoing L4-S1 posterior pedicle screw fusion. All patients underwent successful lateral lumbar interbody fusion (LLIF) at 1-2 levels above their previous constructs, using stand-alone cages, with complete resolution of radiculopathy and a significant improvement in low-back pain. In addition to a thorough analysis of these cases, we review the pertinent literature regarding treatment options for adjacent segment disease and the applications of the lateral lumbar interbody technique.
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Affiliation(s)
- Sheri K Palejwala
- Division of Neurosurgery, University of Arizona Medical Center, 1501 North Campbell Avenue, P.O. Box 2405070, Tucson 85724, USA
| | - Whitney A Sheen
- Division of Neurosurgery, University of Arizona Medical Center, 1501 North Campbell Avenue, P.O. Box 2405070, Tucson 85724, USA
| | - Christina M Walter
- Division of Neurosurgery, University of Arizona Medical Center, 1501 North Campbell Avenue, P.O. Box 2405070, Tucson 85724, USA
| | - Jack H Dunn
- Division of Neurosurgery, University of Arizona Medical Center, 1501 North Campbell Avenue, P.O. Box 2405070, Tucson 85724, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona Medical Center, 1501 North Campbell Avenue, P.O. Box 2405070, Tucson 85724, USA.
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Alimi M, Hofstetter CP, Cong GT, Tsiouris AJ, James AR, Paulo D, Elowitz E, Härtl R. Radiological and clinical outcomes following extreme lateral interbody fusion. J Neurosurg Spine 2014; 20:623-35. [DOI: 10.3171/2014.1.spine13569] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Extreme lateral interbody fusion (ELIF) is a popular technique for anterior fixation of the thoracolumbar spine. Clinical and radiological outcome studies are required to assess safety and efficacy. The aim of this study was to describe the functional and radiological impact of ELIF in a degenerative disc disease population with a longer follow-up and to assess the durability of this procedure.
Methods
Demographic and perioperative data for all patients who had undergone ELIF for degenerative lumbar disorders between 2007 and 2011 were collected. Trauma and tumor cases were excluded. For radiological outcome, the preoperative, immediate postoperative, and latest follow-up coronal Cobb angle, lumbar sagittal lordosis, bilateral foraminal heights, and disc heights were measured. Pelvic incidence (PI) and PI–lumbar lordosis (PI-LL) mismatch were assessed in scoliotic patients. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as the Macnab criteria.
Results
One hundred forty-five vertebral levels were surgically treated in 90 patients. Pedicle screw and rod constructs and lateral plates were used to stabilize fixation in 77% and 13% of cases, respectively. Ten percent of cases involved stand-alone cages. At an average radiological follow-up of 12.6 months, the coronal Cobb angle was 10.6° compared with 23.8° preoperatively (p < 0.0001). Lumbar sagittal lordosis increased by 5.3° postoperatively (p < 0.0001) and by 2.9° at the latest follow-up (p = 0.014). Foraminal height and disc height increased by 4 mm (p < 0.0001) and 3.3 mm (p < 0.0001), respectively, immediately after surgery and remained significantly improved at the last follow-up. Separate evaluation of scoliotic patients showed no statistically significant improvement in PI and PI-LL mismatch either immediately postoperatively or at the latest follow-up. Clinical evaluation at an average follow-up of 17.6 months revealed an improvement in the ODI and the VAS scores for back, buttock, and leg pain by 21.1% and 3.7, 3.6, and 3.7 points, respectively (p < 0.0001). According to the Macnab criteria, 84.8% of patients had an excellent, good, or fair functional outcome. New postoperative thigh numbness and weakness was detected in 4.4% and 2.2% of the patients, respectively, which resolved within the first 3 months after surgery in all but 1 case.
Conclusions
This study provides what is to the authors' knowledge the most comprehensive set of radiological and clinical outcomes of ELIF in a fairly large population at a midterm follow-up. Extreme lateral interbody fusion showed good clinical outcomes with a low complication rate. The procedure allows for at least midterm clinically effective restoration of disc and foraminal heights. Improvement in coronal deformity and a small but significant increase in sagittal lordosis were observed. Nonetheless, no significant improvement in the PI-LL mismatch was achieved in scoliotic patients.
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Affiliation(s)
- Marjan Alimi
- 1Weill Cornell Brain and Spine Institute, Department of Neurological Surgery
| | | | | | | | - Andrew R. James
- 1Weill Cornell Brain and Spine Institute, Department of Neurological Surgery
| | - Danika Paulo
- 1Weill Cornell Brain and Spine Institute, Department of Neurological Surgery
| | - Eric Elowitz
- 1Weill Cornell Brain and Spine Institute, Department of Neurological Surgery
| | - Roger Härtl
- 1Weill Cornell Brain and Spine Institute, Department of Neurological Surgery
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Wang MY, Madhavan K. Mini-Open Pedicle Subtraction Osteotomy: Surgical Technique. World Neurosurg 2014; 81:843.e11-4. [DOI: 10.1016/j.wneu.2012.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/02/2012] [Indexed: 11/29/2022]
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Tempel ZJ, Gandhoke GS, Bonfield CM, Okonkwo DO, Kanter AS. Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis. Neurosurg Focus 2014; 36:E11. [DOI: 10.3171/2014.3.focus13368] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
A hybrid approach of minimally invasive lateral lumbar interbody fusion (LLIF) followed by supplementary open posterior segmental instrumented fusion (PSIF) has shown promising early results in the treatment of adult degenerative scoliosis. Studies assessing the impact of this combined approach on correction of segmental and regional coronal angulation, sagittal realignment, maximum Cobb angle, restoration of lumbar lordosis, and clinical outcomes are needed. The authors report their results of this approach for correction of adult degenerative scoliosis.
Methods
Twenty-six patients underwent combined LLIF and PSIF in a staged fashion. The patient population consisted of 21 women and 5 men. Ages ranged from 40 to 77 years old. Radiographic measurements including coronal angulation, pelvic incidence, lumbar lordosis, and sagittal vertical axis were taken preoperatively and 1 year postoperatively in all patients. Concurrently, the visual analog score (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were used to assess clinical outcomes in 19 patients.
Results
At 1-year follow-up, all patients who underwent combined LLIF and PSIF achieved statistically significant mean improvement in regional coronal angles (from 14.9° to 5.8°, p < 0.01) and segmental coronal angulation at all operative levels (p < 0.01). The maximum Cobb angle was significantly reduced postoperatively (from 41.1° to 15.1°, p < 0.05) and was maintained at follow-up (12.0°, p < 0.05). The mean lumbar lordosis–pelvic incidence mismatch was significantly improved postoperatively (from 15.0° to 6.92°, p < 0.05). Although regional lumbar lordosis improved (from 43.0° to 48.8°), it failed to reach statistical significance (p = 0.06). The mean sagittal vertical axis was significantly improved postoperatively (from 59.5 mm to 34.2 mm, p < 0.01). The following scores improved significantly after surgery: VAS for back pain (from 7.5 to 4.3, p < 0.01) and leg pain (from 5.8 to 3.1, p < 0.01), ODI (from 48 to 38, p < 0.01), and PCS (from 27.5 to 35.0, p = 0.01); the MCS score did not improve significantly (from 43.2 to 45.5, p = 0.37). There were 3 major and 10 minor complications.
Conclusions
A hybrid approach of minimally invasive LLIF and open PSIF is an effective means of achieving correction of both coronal and sagittal deformity, resulting in improvement of quality of life in patients with adult degenerative scoliosis.
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Anand N, Baron EM, Kahwaty S. Evidence Basis/Outcomes in Minimally Invasive Spinal Scoliosis Surgery. Neurosurg Clin N Am 2014; 25:361-75. [DOI: 10.1016/j.nec.2013.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Barbagallo GMV, Albanese V, Raich AL, Dettori JR, Sherry N, Balsano M. Lumbar Lateral Interbody Fusion (LLIF): Comparative Effectiveness and Safety versus PLIF/TLIF and Predictive Factors Affecting LLIF Outcome. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:28-37. [PMID: 24715870 PMCID: PMC3969425 DOI: 10.1055/s-0034-1368670] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Systematic review. STUDY RATIONALE The surgical treatment of adult degenerative lumbar conditions remains controversial. Conventional techniques include posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). A new direct approach known as lumbar lateral interbody fusion (LLIF), or extreme lateral interbody fusion (XLIF(®)) or direct lateral interbody fusion (DLIF), has been introduced. Objectives The objective of this article is to determine the comparative effectiveness and safety of LLIF, at one or more levels with or without instrumentation, versus PLIF or TLIF surgery in adults with lumbar degenerative conditions, and to determine which preoperative factors affect patient outcomes following LLIF surgery. MATERIALS AND METHODS A systematic review of the literature was performed using PubMed and bibliographies of key articles. Articles were reviewed by two independent reviewers based on predetermined inclusion and exclusion criteria. Each article was evaluated using a predefined quality rating scheme. RESULTS The search yielded 258 citations and the following met our inclusion criteria: three retrospective cohort studies (all using historical cohorts) (class of evidence [CoE] III) examining the comparative effectiveness and safety of LLIF/XLIF(®)/DLIF versus PLIF or TLIF surgery, and one prospective cohort study (CoE II) and two retrospective cohort studies (CoE III) assessing factors affecting patient outcome following LLIF. Patients in the LLIF group experienced less estimated blood loss and a lower mortality risk compared with the PLIF group. The number of levels treated and the preoperative diagnosis were significant predictors of perioperative or early complications in two studies. CONCLUSION There is insufficient evidence of the comparative effectiveness of LLIF versus PLIF/TLIF surgery. There is low-quality evidence suggesting that LLIF surgery results in fewer complications or reoperations than PLIF/TLIF surgery. And there is insufficient evidence that any preoperative factors exist that predict patient outcome after LLIF surgery.
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Affiliation(s)
- Giuseppe M. V. Barbagallo
- Division of Neurosurgery, Department of Neurosciences, Policlinico University Hospital, Catania, Italy
| | - Vincenzo Albanese
- Division of Neurosurgery, Department of Neurosciences, Policlinico University Hospital, Catania, Italy
| | - Annie L. Raich
- Spectrum Research, Inc., Tacoma, Washington, United States
| | | | - Ned Sherry
- Spectrum Research, Inc., Tacoma, Washington, United States
| | - Massimo Balsano
- Regional Spinal Department, Alto Vicentino, OC Santorso, Vicenza, Italy
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Dahdaleh NS, Smith ZA, Snyder LA, Graham RB, Fessler RG, Koski TR. Lateral Transpsoas Lumbar Interbody Fusion. Neurosurg Clin N Am 2014; 25:353-60. [DOI: 10.1016/j.nec.2013.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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