A Cadaveric Radiographic Analysis on the Effect of Extreme Lateral Interbody Fusion Cage Placement With Supplementary Internal Fixation on Indirect Spine Decompression

Marulanda, German A.; Nayak, Aniruddh N.; Murtagh, Ryan; Santoni, Brandon G.; Billys, James B.; Castellvi, Antonio E.

doi:10.1097/bsd.0b013e31828f9da1

Cited by 27 publications

(12 citation statements)

References 10 publications

(18 reference statements)

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“…Specifically, in the acute term, we noted 24%, 31%, 67%, and 7% increases in right and left foraminal area, disc height, and canal area, respectively. These acute findings are in agreement with our prior radiographic findings in cadaveric lumbar spines instrumented with laterally placed cages and supplemental internal fixation [13]. Our in vitro study results indicated increases in disc height ([ 30%), foraminal area ([ 35%), and canal area ([ 30%).…”

Section: Discussionsupporting

confidence: 91%

“…In a previously published cadaver study [13], we demonstrated that interbody cage placement through the lateral transpsoas approach increased disc height, foraminal areas, and central canal area when compared to the noninstrumented lumbar spine. In a separate biomechanical study, we demonstrated that pedicle screw and rod instrumentation provided the best limitation to motion of the spinal segments [15].…”

Section: Introductionmentioning

confidence: 59%

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Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Castellvi

Nienke

Marulanda

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion. Question/purposes We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach. Methods Between 2008 and 2012, 158 patients were surgically treated to alleviate symptoms associated with degenerative lumbar stenosis, of whom 60 (38%) were treated with lateral lumbar interbody fusion. Of these 60 patients, 36 (60%) received CT scans preoperatively and at 1-year postoperatively and were available for radiographic analysis. Of the 60 treated patients, 16 (27%) were lost to followup before 12 months, leaving the records of 44 patients available for review of patient-reported improvements in pain and return to function. Radiographic increases in disc height, foraminal area, and canal area were measured by one observer on CT scans postoperatively and at 1 year and compared to preoperative values. Patient-reported scores, including VAS pain score and Oswestry Disability Index (ODI), were collected preoperatively and at 3 and 12 months postoperatively.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 59%

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Castellvi

Nienke

Marulanda

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…14 , 15 Surgical invasiveness was defi ned using an invasiveness index for spine surgery developed by Mirza et al . [28][29][30][31] This approach involves transpsoas access to the anterior lumbar vertebral column, and has been associated with lumbar plexus injury and persistent neurological defi cits. However, the risk of specifi c intraoperative procedures has not been assessed before.…”

Section: Discussionmentioning

confidence: 99%

Incidental Durotomy During Spinal Surgery

Aichmair

Kueper

et al. 2014

Spine

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“…LLIF offers several advantages over posterolateral fusion, including indirect foraminal decompression and correction of spinal alignment (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion

Kiely

Bogner

et al. 2017

J. Spine Surg.

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Background: To assess the clinical outcomes of 44 patients who underwent single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw instrumentation through a paramedian Wiltse approach.Methods: Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative plain radiographs were assessed for subsidence, cage migration, and fusion.Results: Average age of patients at surgery was 60.8±10.6 years (range, 32-79 years), with 15 males and 29 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was used in 32 cases (73%) and 13 posterolateral fusions (30%). Average duration of surgery was 195.2±36.9 minutes (range: 111-295 minutes), with an estimated blood loss of 159.3±90.8 cc (range, 50-500 cc). There were no intra-operative complications.Average length of hospital stay was 4.2±2.5 days (range, 2-13 days). Four patients (9%) experienced neurological deficit, 2 of which resolved by 3-month follow-up and 2 of which improved but did not resolve by final follow-up at 11 and 16 months. There was significant improvement in VAS (P<0.001), ODI (P<0.001), and SF-12 physical component (P<0.001), but not for SF-12 mental component (P=0.053). Patients with minimum 6 months radiographic follow-up demonstrated successful fusion in 90% of cases (35/39), with 2 cases of grade 1 (5%) subsidence of the adjacent cranial vertebra, and no cases higher than grade 0 subsidence of the adjacent caudal vertebra.Conclusions: Unilateral pedicle screw instrumentation following LLIF was associated with significant improvement in clinical outcomes and favorable radiographic outcomes.

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A Cadaveric Radiographic Analysis on the Effect of Extreme Lateral Interbody Fusion Cage Placement With Supplementary Internal Fixation on Indirect Spine Decompression

Cited by 27 publications

References 10 publications

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Incidental Durotomy During Spinal Surgery

Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion

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