Comparison of pure lateral and oblique lateral inter-body fusion for treatment of lumbar degenerative disk disease: a multicentric cohort study

ObjectiveSurgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis.MethodsThis was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively.ResultsThe mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05).ConclusionOne‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.

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“…Lee et al . and Miscuis et al . report that surgery through the OLIF corridor could be safely conducted without electrophysiological monitoring.…”

Section: Discussionmentioning

confidence: 99%

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

Tong

Liu

Fan

et al. 2019

Orthopaedic Surgery

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“…At present, there are a number of studies on OLIF for the treatment of lumbar degenerative diseases, such as spondylolisthesis, lumbar spinal stenosis, and spinal deformity [2,3]. Although OLIF reduces the risks of direct damage to the dural sac and the nerve root compared with traditional PLIF or transforaminal lumbar interbody fusion (TLIF), OLIF is associated with catastrophic complications, such as large retroperitoneal vessels, due to the limited operation approach between the psoas muscle and retroperitoneal vessels.…”

Section: Discussionmentioning

confidence: 99%

A patient with left-sided inferior vena cava who received oblique lumbar interbody fusion surgery: a case report

et al. 2020

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Background: Oblique lateral interbody fusion surgery has become increasingly popular for lumbar degenerative diseases. The oblique corridor is between the psoas muscle and the retroperitoneal vessels, and its use could result in decreased tissue trauma, minimal blood loss, and short operation times. Patients who undergo oblique lateral interbody fusion surgery are always placed in the right lateral position to avoid damage to the inferior vena cava, which is typically a right-sided vessel. There is a substantial risk of vascular injury during the operation if there are anatomical variations in the vessels. Case presentation: A 77-year-old man, of the Han nationality, with lumbar spinal stenosis underwent stand-alone oblique lateral interbody fusion surgery. Transverse magnetic resonance imaging of the lumbar spine indicated that his inferior vena cava was left-sided. A three-dimensional reconstructed image of abdominal computed tomography angiography showed that the inferior vena cava was located on the left side. Finally, the surgeon decided to change the position of our patient from a right lateral position to a left lateral position before the surgery. Conclusions: To date, this is the first reported case where a patient underwent oblique lateral interbody fusion surgery in a left lateral decubitus position due to a left-sided inferior vena cava. This case demonstrates that carefully reading radiological results is important for operation planning and avoiding anatomical complications.

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“…5,6 Minimally invasive lateral lumbar interbody fusion (LLIF) is now considered to be a standard approach for degenerative lumbar disorders. [24][25][26] Nevertheless, LLIF has some limits that need to be disclosed: neuromoni- toring is strictly needed due to the nonnegligible risk for nerve root injuries; the procedure cannot be performed at L5-S1 due to the iliac crest projection; and it is burdened by an intrinsic morbidity because of the violation of the psoas muscle. The necessity for aborting this procedure during the psoas transgression, especially for a highly degenerated and rotated L4-5 segment, is also a commonly reported experience.…”

Section: Discussionmentioning

confidence: 99%

“…We do not report any vascular injury, probably due to our previous experience in lateral, anterolateral, and anterior approaches to the lumbar spine. 26 All patients of this series have been operated on by the two senior surgeons, without the need for an access surgeon, who nevertheless always remained available in case of need. Therefore, the reported outcomes may not reveal the early learning phase of the ATP approach.…”

Section: Fig 4 Illustrative Case From Group B Showing Fusion On Sagmentioning

confidence: 99%

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

Miscusi

Trungu

Ricciardi

et al. 2020

Neurosurgical Focus

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OBJECTIVEOver the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5–S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5–S1 segment in a single cohort of patients.METHODSThis is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5–S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively.RESULTSThirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44–75 years). The mean follow-up was 33.1 months (range 13–48 months). The mean pre- and postoperative visual analog scale (7.9 ± 1.3 vs 2.4 ± 0.8, p < 0.05), Oswestry Disability Index (52.8 ± 14.4 vs 22.9 ± 6.0, p < 0.05), and SF-36 (37.3 ± 5.8 vs 69.8 ± 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5–S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence–lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis.CONCLUSIONSIn the present case series, ATP fusion for the L5–S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5–S1 conditions.

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Comparison of pure lateral and oblique lateral inter-body fusion for treatment of lumbar degenerative disk disease: a multicentric cohort study

Cited by 39 publications

References 27 publications

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

A patient with left-sided inferior vena cava who received oblique lumbar interbody fusion surgery: a case report

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

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