Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

Deukmedjian, Armen R.; Dakwar, Elias; Ahmadian, Amir; Smith, Donald A.; Uribe, Juan S.

doi:10.1100/2012/789698

Cited by 105 publications

(58 citation statements)

References 37 publications

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“…Advanced techniques of minimally invasive sagittal plane correction have been described in the literature. 1,13,14,35,37 For example, Deukmedjian et al 13 used the lateral transpsoas approach to release the anterior longitudinal ligament and place a hyperlordotic interbody cage in 7 patients, gaining an average of 17° per level of anterior longitudinal ligament release. Similar results were described by Akbarnia et al 1 and Uribe et al, 35 who discovered a 21° increase in lumbar lordosis and a 10°-20° increase in segmental lordosis, respectively, with anterior column realignment.…”

Section: Discussionmentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

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129

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Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

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Section: Discussionmentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

Self Cite

129

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“…5). Other techniques such as minimally invasive anterior longitudinal ligament release, 9 anterior lumbar interbody fusion (ALIF) at L5-S1, or posterior column osteotomies may afford increased lordosis, and thus, better result in correction of the SVA. In terms of achieving a postoperative pelvic incidence minus lumbar lordosis parameter within 10 mm, we noted a PI-LL mismatch of 38° on average to be the maximum value of preoperative mismatch that could be corrected using our described minimally invasive techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, recent techniques involving an anterior longitudinal ligament release may allow for even more lordosis creation. 9 The use of the transsacral AxiaLIF technique may also have limited our ability to gain maximal lordosis at L5-S1, especially in patients with significant positive sagittal balance. We traditionally have used the AxiaLIF for interbody fixation rather than to achieve lordosis.…”

Section: Discussionmentioning

confidence: 99%

Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

Anand¹,

Baron

Khandehroo³

2014

FOC

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Object Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results The mean preoperative SVA value was 60 mm (range 11.5–151 mm); the mean postoperative value was 31 mm (range 0–84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°–74.7°) and a mean postoperative value of 13.9° (range 0°–32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Conclusions Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.

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“…Deukmedjian et al 24) performed LLIF with use of allograft for seven adult spinal deformity cases; however, the fusion rate was not reported. Rodgers et al 7) reported three uncertain levels for fusion (3.4%) out of 88 LLIF levels with use of local bone augmented with demineralized bone matrix and cancellous allograft.…”

Section: Discussion Discussion Discussionmentioning

confidence: 99%

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors

Satake

Kanemura

Nakashima

et al. 2018

Spine Surg Relat Res

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Methods Methods Methods MethodsSixty-three patients who underwent transpsoas LLIF (69.8 ± 8.9 years, 21 males and 42 females, 125 segments) were followed for a minimum 2 years postoperatively. For all LLIF segments, polyetheretherketone (PEEK) cages packed with allogenic bone were applied with supplemental bilateral pedicle screws (PSs). Bone bridge formation was evaluated by computed tomography (CT) 2 years postoperative, and a segment without any bridge formation was determined to be a nonunion. Sixty-one participants (96.8%) were classified into two groups for clinical evacuation: Group N that contained one or more nonunion segments and Group F that contained no nonunion segment. Visual analogue scales (VAS)scores and the effective rates of the five domains of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared between Groups N and F.The risk factors for nonunion were determined by univariate and multivariate analyses. Results Results Results Results 3Twenty segments (16%) were diagnosed as nonunion. There were no significant differences in all VAS scores, and the ratio of effective cases in all domains of JOABPEQ between Group N (n = 14) and F (n = 47). Multivariate analysis identified percutaneous PS (PPS) usage (odds ratio [OR]: 3.14, 95% confidence interval: 1.13-8.68, p = 0.028) as a positive risk factor for nonunion. Conclusions Conclusions Conclusions ConclusionsWe should be aware of the higher nonunion rate in the LLIF segments supplemented with PPS, though nonunion does not affect significantly clinical outcomes at 2 years postoperative.

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Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

Cited by 105 publications

References 37 publications

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors

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