Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique

Kueper, Janina; Fantini, Gary A.; Walker, Brendon; Aichmair, Alexander; Hughes, Alexander P.

doi:10.1007/s00586-015-3796-2

Cited by 49 publications

(37 citation statements)

References 24 publications

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“…Using an identical oblique lumbar interbody fusion technique, Silvestre et al [44] reported a vascular complication risk of 1.68% including iliac and iliolumbar venous lacerations. These results are comparable to those for far lateral approaches such as the extreme lateral transpsoas approach, which were developed specifically to avoid vascular injury, and which range from 0% to 0.11% in large case series [22,40]. All three vessel lacerations in our series involved the L4-L5 segment, and we recommend careful and meticulous preparation and more posterior dissection of the anterior border of the psoas muscle.…”

Section: Discussionsupporting

confidence: 77%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

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Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoassparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported. Questions/purposesWe asked: what proportion of patients experienced (1) perioperative complications (overall complications), (2) vascular complications, and (3) neurologic complications after less-invasive anterior lumbar interbody fusion through the oblique lumbar interbody approach at one high-volume center? Methods We performed a chart review of intra-and perioperative complications of all patients who had undergone minimally invasive anterior lumbar interbody fusion through a lateral psoas-sparing approach from L1 to L5 during a 12-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). During the study period, the oblique, psoas-sparing approach was the preferred approach of the participating surgeons in this study, and it was performed in 812 patients, all of whom are studied here, and all of whom have complete data for assessment of the short-term (inpatient-only) complications that we studied. In general, we performed this approach whenever possible, although it generally was avoided when a patient previously had undergone an open retro-or transperitoneal abdominal procedure, or previous implantation of hernia mesh in the abdomen. During the study period, posterior fusion techniques were used in an additional 573 patients instead of the oblique lumbar interbody fusion when we needed to decompress the spinal canal beyond what is possible through the anterior approach. In case of spinal stenosis calling for fusion in combination with a high disc space, severe endplate irregularity, or severe biomechanical instability, we combined posterior decompression with oblique lumbar interbody fusion in 367 patients. Complications were evaluated by an independent observer who was not involved in the decisionmaking process, the operative procedure, nor the Each author certifies that he or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 ed...

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Section: Discussionsupporting

confidence: 77%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

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“…This tubular dilator based technique has recently been modified to a single incision mini-open access technique, which is utilized at our institution. This technique allows for direct visualization of retroperitoneal and neural structures, digital palpation of the target disc as well as electrophysiological neurologic confirmation during the procedure [26]. Our institution's experience regarding sensorimotor complications and vascular injuries using the mini-open access technique has previously been published [26][27][28][29].…”

Section: Evolution Of the Techniquementioning

confidence: 99%

“…The overall incidence of vascular injury at our institution using LLIF is 0.056% per case and 0.029% per level. The mini-open access technique has been shown to be useful for immediate repair of minor vascular injuries [26]. Although rare, potentially lethal major vascular complications during LLIF are possible.…”

Section: Vascular Injurymentioning

confidence: 99%

“…The originally described LLIF technique uses two incisions through which tubular dilators and an expandable retractor are successively inserted [5,26]. Since no direct visualization is possible, this technique relies on handheld electrophysiological monitoring devices to avoid injury to the exiting nerve roots and lumbar plexus.…”

Section: Evolution Of the Techniquementioning

confidence: 99%

“…The muscles are sequentially split in minimal fashion, along the direction of their respective fibers [26]. The retroperitoneal space is then entered and developed under direct vision.…”

Section: Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

Self Cite

115

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Purpose of Review Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications. Recent Findings Since the first description of the technique in 2006, the indications for LLIF have expanded and the rate of LLIF procedures performed in the USA has increased. LLIF has several theoretical advantages compared to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern. Summary In well-indicated patients, LLIF can be a safe procedure used for a variety of indications.

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Techniques for Avoiding Psoas Muscle and Lumbosacral Plexus Injury

Gary

Wang

2016

Lateral Access Minimally Invasive Spine Surgery

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Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique

Abstract: The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.

Cited by 49 publications

References 24 publications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Techniques for Avoiding Psoas Muscle and Lumbosacral Plexus Injury

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