L5/S1 anterior lumbar interbody fusion technique

Mobbs, Ralph J.; Lennox, Andrew; Ho, Yam-Ting; Phan, Kevin; Choy, Wen Jie

doi:10.21037/jss.2017.09.02

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…However, the iliac crest and abnormal sagittal angle at the L5-S1 level result in a decreased ability to restore foraminal height and lumbar lordosis when compared to other levels [ 18 - 19 ]. The ALIF is particularly suited to the L5-S1 level due to easier vascular access below the bifurcation of the aorta and inferior vena cava and the ability to place a large, lordotic cage following discectomy [ 20 - 21 ]. However, as an anterior approach, it often requires an access surgeon, and the patient must be repositioned for posterior instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Abbasi¹,

Storlie²,

Aya³

2022

Cureus

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The oblique lateral lumbar interbody fusion (OLLIF) is a relatively new method of lumbar interbody fusion (LIF) that utilizes a trans-Kambin approach to the disc space. The OLLIF can be performed from T12-S1 in the majority of cases but is occasionally obstructed at the L5-S1 level by osteophytes, an overgrown facet joint and/or prominent sacral ala. Transfacet OLLIF (TF-OLLIF) is a novel method for LIF in which the disc space is accessed by drilling through hypertrophic facets with an OLLIF approach. We provide a proof-ofconcept report on the TF-OLLIF surgical technique and report the clinical and perioperative outcomes for the first 29 patients who underwent this procedure. MethodsThis is a retrospective single surgeon cohort study of 29 patients with lumbar spinal stenosis (LSS) who underwent TF-OLLIF procedures between 8/2018 and 1/2021. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were surgery time, blood loss, hospital stay, and complications. The TF-OLLIF was performed using the approach and instrumentation of OLLIF. When osseous hypertrophy is reached during the approach, an 8 mm drill is used to drill through the obstructing bone with continuous neuromonitoring. Discectomy and interbody placement are performed with subsequent posterior pedicle screw fixation. ResultsODI improved from 49% pre-op to 31% at one-year follow-up. Estimated blood loss ranged from 97.6±93.3 ml for one level TF-OLLIF to 146.2±60.3 ml for a 3+ level TF-OLLIF. Operative time ranged from 57.4±19.5 minutes for a one-level TF-OLLIF to 102.9±27.8 minutes for a 3+ level TF-OLLIF. The average length of hospital stay (LOS) was 0.4±0.8 days for one-level TF-OLLIF and 1.6±1.9 days for 3+ level TF-OLLIF. Complications included five cases of nerve root irritation immediately postoperatively, with three of these patients still reporting mild L5 distribution numbness at the last follow-up, which was not clinically limiting. ConclusionThe first 29 cases of TF-OLLIF demonstrated that it is a safe method of interbody fusion that yields good clinical results. This is an important development for practitioners of OLLIF as it enables interbody placement with OLLIF instruments and approach even for challenging L5-S1 levels without compromising surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Abbasi¹,

Storlie²,

Aya³

2022

Cureus

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“…The anterior approach requires access through the abdomen using a retroperitoneal approach, with the potential risk of vascular and visceral injuries, and retrograde ejaculation [25]. This approach can be technically challenging and increasingly an access surgeon is used for safe and adequate exposure [26]. The main concern with the posterior fusion approaches (PLIF and TLIF) is the extent of neural retraction required, with the potential for nerve root injury, dural tears, epidural bleeding and subsequent epidural fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Fusion of the L5-S1 Segment in Degenerative Lumbar Spine Disease Using the Extreme Lateral Interbody Fusion Technique: A Case Report Study

Schmid¹,

Krappel²,

Marmentini³

2019

Arch Clin Med Case Rep

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Study design: This study is a single center case report study with 3 cases of degenerative lumbar spine disease treated with the XLIF procedure at the level L5-S1. Objective:The purpose of this case report study is to demonstrate the possibility of treating degenerative lumbar spine disease at the level L5-S1 using the XLIF procedure.Summary and Background of Data: There are several standard surgical techniques for the treatment of degenerative lumbar spine diseases that have failed conservative treatment. Interbody fusion can restore the proper alignment of the spine hereby leading to indirect decompression of the nerve roots. The XLIF procedure is a relatively recent retroperitoneal and transpsoas major muscle approach allowing the insertion of interbody implants. This approach has shown good results but for anatomical reasons it is limited at the lumbar spine to the segments L1-L5.Methods: A single center case report study with 3 cases of degenerative lumbar spine disease treated with the XLIF procedure at the level L5-S1.Results: All 3 patient were successfully operated at the level L5-S1 with an XLIF procedure. Conclusion:This case series suggests that the XLIF procedure is a safe, feasible and timesaving procedure to treat the segment L5-S1 in selected patients with severe degenerative lumbar spine disease and failed conservative

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“…This anterior approach is well established for lumbar spinal interbody fusion surgery or lumbar disk replacement, with indications including degenerative disk disease, spondylolisthesis, and correction of scoliosis. [11][12][13] The anterior approach has advantages over posterior lumbar surgery as there is no breach of the paraspinal musculature, no resection of the posterior bony neural arch, and no manipulation of the cauda equina nerve roots and thecal sac. The risk of iatrogenic injury to these structures is thus greatly reduced.…”

Section: Image Analysismentioning

confidence: 99%

Sonographic Assessment of Human Lumbar Intervertebral Disks: A Cadaveric Study

Winn

Balain

Ockendon

et al. 2021

Journal of Diagnostic Medical Sonography

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Objectives: The intervertebral disk has traditionally been imaged by magnetic resonance imaging (MRI); however, advances in sonography mean it can now be visualized with this modality. The objectives of this human cadaveric study were to visualize the internal structure of the lumbar intervertebral disks and map any defects. Shear wave sonography was explored as a method for assessing the disks. Materials and Methods: In a human cadaver, L4-L5 and L5-S1 disks were imaged with sonography through the anterior abdominal wall and directly through the anterior longitudinal ligament. Gray-scale images and shear wave elastography velocities were obtained. An MRI was performed for image comparison. Results: Defects in the disks were clearly seen with sonography, imaging through the anterior abdominal wall and also directly through the anterior longitudinal ligament. The defects identified on sonography were less well visualized on MRI. Shear wave velocities could only be obtained from the anterior aspect of the disk and were unreliable, primarily owing to the stiffness of the tissues. Conclusion: Sonography can provide an accurate map of defects within the disk, corresponding with MRI. Shear wave elastography should be used with caution in the human cadaveric intervertebral disk, acknowledging the many confounding factors influencing the measurements.

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L5/S1 anterior lumbar interbody fusion technique

Abstract: Figure 4Postoperative X-ray (day 1) and CT scan (3 months) demonstrating excellent implant position, restoration of disc height and focal lordosis.

Cited by 13 publications

References 14 publications

Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Fusion of the L5-S1 Segment in Degenerative Lumbar Spine Disease Using the Extreme Lateral Interbody Fusion Technique: A Case Report Study

Sonographic Assessment of Human Lumbar Intervertebral Disks: A Cadaveric Study

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