Clinical Outcome and Fusion Rates after the First 30 Extreme Lateral Interbody Fusions

Malham, Gregory M.; Ellis, N.; Parker, Rhiannon M.; Seex, Kevin

doi:10.1100/2012/246989

Cited by 115 publications

(92 citation statements)

References 35 publications

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“…One-way within-groups ANOVA analysis showed statistically significant differences ODI {F [3,24] =8.70, P<0.001}, VASb {F [3,18] =10.67, P<0.001} and the Table 1). Preoperative ODI scores ranged between 2 and 80 (average 48.7).…”

Section: Resultsmentioning

confidence: 99%

“…The standard approach for their insertion is by a 90 degrees lateral transpsoas method (2). This is a relatively bloodless technique (50 mLs per level) compared to other interbody fusion techniques but has its limitations (3). Neuro-monitoring is essential and the L4/5 level can be difficult because of iliac crest obstruction or an anterior plexus position (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Gragnaniello

Seex

2016

J. Spine Surg.

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Background: Lateral interbody cages have been proven useful in spinal fusions. Spanning both lateral cortical rims while sparing the Anterior Longitudinal Ligament, the lateral interbody cages restore and maintain disc height while adding stability prior to supplemental fixation. The standard approach for their insertion is by a 90-degree lateral transpsoas method. This is relatively bloodless compared to other techniques although has its limitations, requiring neuro-monitoring and being, at times, very difficult at L4/5 due to iliac crest obstruction or an anterior plexus position. An oblique approach, with the patient in lateral decubitus, passes anterior to the iliac crest, retroperitoneal, and being anterior to psoas, eliminates the need for neuro-monitoring.Methods: Twenty-one consecutive patients underwent surgery for a total of 32 levels instrumented with the ATP technique. Mean age at the time of surgery was 62.4±7.4 years. There was a 6 months minimum clinical follow up, with imaging to assess fusion, at 6 and 12 months. Indications included symptomatic degenerative lumbar spondylosis +/− spondylolisthesis, leg and back pain. All patients were assessed with the Oswestry Disability Index (ODI), Visual Analog Scale 100 mm for back pain (VASb) and for leg pain (VASl) preoperatively, at 3, 6 and 12 months. Last follow-up was at 12 months for 9 patients and the rest had 6 months follow up.Results: Statistical analysis showed significance for the results in ODI, VASb and VASl with improvement in all components except for one patient with worsening VASl. Eight patients had complications related to surgery which were still present at last follow-up including moderate weakness of hip flexion and EHL weakness. Lateral cutaneous nerve (LCN) palsy on the side of the approach was also seen as well as sympathectomy effect related to the mobilization of the sympathetic trunk. One patient, who also suffered from multiple sclerosis, experienced psoas abscess 3 months post op that required drainage. Conclusions:The left sided anterior to psoas approach offers the most natural corridor to the disc space.The novel instruments and method described here allows insertion of large lateral cages between L2 to L5, without the problems associated with the transpsoas approach, particularly at L4/5.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Gragnaniello

Seex

2016

J. Spine Surg.

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“…Several reports have described postoperative cage subsidence in LIF series, with an incidence of 0.3%-22% [1][2][3] . Many reports have mixed two types of cage subsidence, one results from intraoperative endplate injury and the other (late-onset settling) occurs gradually over the postoperative course.…”

Section: Introductionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.

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“…-0 1 -0% ---Lykissas et al [31] 295 ± 180 ---135% ---Grimm et al [32] 122 -181 -20% -3.0 -Tohmeh et al [33] ----48% ---Berjano et al [34] ----16% ---Lee et al [26] 52 ± 19 -0 [35] 73 ± 31 -< 50 -29% ---Sharma et al [36] ----70% ---Pimenta et al [25] 130 ---28% -1.4 -Ahmadian et al [37] --94 ---3.5 -Caputo et al [38] ----2 ---Malham et al [39] 84 -70 -20% ---Pimenta et al [40] 69 ± 11 -< 50 -13% ---Elowitz et al [41] ----20% 3 ---Oliveira et al [42] cutive, odd/even patient order). In Table 6 [45] polled patients on postoperative day 2, finding a VAS back of 2.2 ± 0.6 in MIS patients and 4.3 ± 0.5, a statistically significant difference (P < 0.05).…”

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confidence: 99%

“…Marchi et al [35] 2012 XLIF PCS Spondylolisthesis 52 -Sharma et al [36] 2011 XLIF RCS Spondylosis ± listhesis, scoliosis 43 -Pimenta et al [25] 2011 XLIF PCS DDD 36 -Ahmadian et al [37] 2013 XLIF RCS L4/L5 spondylolisthesis 31 -Caputo et al [38] 2012 XLIF PCS Scoliosis 30 -Malham et al [39] 2012 XLIF PCS DDD, spondylolisthesis, scoliosis 30 - 4 Pimenta et al [40] 2013 XLIF RCT L4/L5 DDD 30 -Elowitz et al [41] 2011 XLIF PCS LSS 25 -Oliveira et al [42] [27] ----28% 24% --Smith et al [28] 112 ± 31 173 ± 31 90 ± 74 311 ± 370 3% 6% 1.7 ± 1.3 3.6 ± 0.9 Rodgers et al [12] --1.4 g Hb 2.7 g Hb --1.3 5.3 Huang et al [29] 176 ± 8 202 ± 15 572 ± 93 970 ± 209 --11.6 ± 1.3 12.5 ± 1.3 Case series Rodgers et al [13] --1.38 g Hb -1% -1.2 -Ruetten et al [30] …”

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confidence: 99%

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

Skovrlj¹

2015

WJO

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AIM:To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS). METHODS:A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant. RESULTS:

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Clinical Outcome and Fusion Rates after the First 30 Extreme Lateral Interbody Fusions

Cited by 115 publications

References 35 publications

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

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