Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Sofianos, DʼMitri; Briseño, Michael R.; Abrams, Joshua; Patel, Alpesh A.

doi:10.1007/s11999-011-2088-3

Cited by 96 publications

(51 citation statements)

References 30 publications

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“…Until now these cages have been inserted by a transpsoas approach which requires neuro-monitoring and can be difficult at L4/5 particularly in men with a large psoas and a high iliac crest (11). In order to reduce sensory complications and difficulties particularly at L4/5, we modified Mayer's 11 approach late in 2011 helped by the development of a custom retractor system and offset instruments to avoid the iliac crest.…”

Section: Discussionmentioning

confidence: 99%

“…For more than 2 levels the author usually splits the deeper 2 muscles twice, having extended the external oblique split. The term "sliding window" has been used to describe the mobility of the skin incision (11).…”

Section: Incisionmentioning

confidence: 99%

“…An oblique approach, with the patient in a lateral position passes anterior to the iliac crest, remains retroperitoneal, and eliminates the need for neuro-monitoring by staying entirely anterior to psoas. Reports of this approach are few, most obviously beginning with Mayer in 1997 and more recently Silvestre in 2012 (2,11), a similar approach called OLIF 25 TM has recently been published by Medtronic Inc (Memphis, TN, USA). While the oblique approach to the disc spaces appears logical, an oblique direction during insertion of the interbody means that short iliac crest graft or TLIF style cages have been recommended to avoid contralateral neural injury, should the graft go too far.…”

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: Discussionmentioning

confidence: 99%

Section: Incisionmentioning

confidence: 99%

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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“…One retrospective study by Sofianos et al analyzed complications of lateral lumbar interbody fusions, which are performed away from the dura, and found a 2% durotomy rate. 39 The durotomy rates in studies entirely composed of open-approach decompression without fusion ranged from 3.2% with discectomy alone 36 to 10.5% in a series by Smorgick et al in which approximately one-third of the patients had undergone prior spinal surgery. The durotomy incidence in a group of patients who underwent revision surgery was 25% (29 of 116) and was not associated with the years of experience of the surgeon performing the procedure.…”

Section: Open Lumbar Proceduresmentioning

confidence: 99%

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Ghobrial

Theofanis

Darden

et al. 2015

FOC

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OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different. CONCLUSIONS Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.

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“…Psoas weakness has a reported incidence as high as 55 % [41,52,53] and is often due to muscle dissection [54]. Tormenti et al [55] reviewed complications of adult scoliosis patients following combined transpsoas LLIF and PSF.…”

Section: Anteriormentioning

confidence: 99%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

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Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Cited by 96 publications

References 30 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

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Neurological complications in adult spinal deformity surgery

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