Lateral Lumbar Interbody Fusion (LLIF): An Update

Rabau, Oded; Navarro-Ramírez, Rodrigo; Aziz, Mina; Teles, Alisson Roberto; Ge, Susan; Quillo-Olvera, Javier; Ouellet, Jean

doi:10.1177/2192568220910707

Cited by 30 publications

(23 citation statements)

References 22 publications

(105 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since its introduction in 2006 10 , lateral lumbar interbody fusion (LLIF) surgery has been used to treat various spinal pathologies 11 , 12 . Some groups have adopted it as an adjunct in corrective surgery for spinal deformity 13 – 15 .…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Hiyama

Katoh

Sakai

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Sagittal misalignment has been associated with negative quality of life (QOL). However, there is no report on whether differences in preoperative sagittal misalignment in patients with lumbar degenerative diseases affect postoperative results after lateral lumbar interbody fusion (LLIF). We investigated whether preoperative sagittal alignment influences the correction of alignment after surgery and whether the preoperative sagittal alignment affects the rating of low back pain, leg pain, and leg numbness. The subjects were 81 patients (48 male, 33 females, average age at surgery 70.2 years) who underwent anterior–posterior combined surgery with LLIF and percutaneous pedicle screws from May 2018 to July 2020. Cluster analysis was performed using the preoperative sagittal vertical axis (SVA) value, and patients were classified into two groups (group 1; n = 30, SVA = 129.0 ± 53.4 mm, group 2; n = 51, SVA = 30.8 ± 23.5 mm). Baseline demographics and treatment data were compared between groups. Sagittal and pelvic parameters and pain scores, such as low back pain, leg pain, and leg numbness, were also compared. Operative time, blood loss, and length of hospital stay did not differ significantly between groups. The changes (Δ) in SVA and lumbar lordosis (LL) for all patients from before to after surgery were not significant (ΔSVA; p = 0.218, ΔLL; p = 0.189, respectively). The SVA, LL, and PI − LL changed significantly after the surgery in group 1, but no marked improvement in sagittal imbalance was obtained after LLIF surgery. The improvement in each pain score from before to after the surgery did not differ significantly between groups. LLIF surgery has a limited chance of recovering sagittal imbalance. However, postoperative low back pain, leg pain, and leg numbness may be improved by LLIF surgery, regardless of the preoperative sagittal alignment.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Hiyama

Katoh

Sakai

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Lateral lumbar interbody fusion (LLIF) is a minimally invasive retroperitoneal approach that can improve patient reported outcomes while possibly reducing some of the risks associated with anterior or posterior interbody approaches to the spinal column. [1][2][3][4] Compared to posterior approaches, LLIF allows for reduced posterior muscle damage, and larger cage placement; larger cage placement may result in greater improvement in sagittal alignment, foraminal height, and a more favorable biomechanical environment for arthrodesis. [5][6][7][8][9] Compared to anterior interbody techniques, LLIF may be associated with less blood loss and a lower risk of vascular injury as the working corridor is further away from the major abdominal vessels.…”

Section: Introductionmentioning

confidence: 99%

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Alluri

Clark

Sheha

et al. 2021

Global Spine Journal

View full text Add to dashboard Cite

Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

show abstract

“…LLIF is a relatively recent development in spine surgery, providing minimally invasive access for indirect nerve decompression, interbody fusion, and correction of lumbar degenerative deformity [ 14 - 16 ]. This technique represents a safe alternative to posterior spinal approaches and has gained acceptance among surgeons over the last decade due to favorable patient outcomes, as evidenced by radiographic parameters and clinical improvement [ 15 , 16 ]. Gaining surgical proficiency using this approach is challenging, and appropriate resident exposure to these cases is highly variable between programs and countries.…”

Section: Discussionmentioning

confidence: 99%

Creation of a Proof-of-Concept 3D-Printed Spinal Lateral Access Simulator

Pullen¹,

Valero-Moreno²,

Rajendran³

et al. 2022

Cureus

View full text Add to dashboard Cite

Background Minimally invasive lateral lumbar interbody fusion (LLIF) offers advantages over traditional approaches, providing indirect decompression of neural elements and deformity correction while avoiding many challenges and risks of anterior and posterior approaches. Mastering this technique requires a specialized team, advanced equipment, and sufficient case exposure. Current training is limited to the classic educational model, and alternative training methods such as cadaver labs can be inconvenient, inaccessible, expensive, and incompatible with intraoperative neuromonitoring (IONM) systems. Objective The aim of this study was to create a proof-of-concept, low-cost, fully synthetic lateral lumbar surgical simulator and to increase awareness of the lack of current training alternatives. Methods Standard engineering design and expert interviews of attending neurosurgeons, nurses, engineers, and medical device representatives (n=20) were utilized to determine key elements for the simulator, physical characteristics of the components, and translational strategy. Physical and radiographic testing was performed on multiple thermoplastics to determine appropriateness for inclusion in the simulator. For evaluation of the concept, a descriptive slide deck and questionnaire were sent to 15 U.S. and 15 international surgeons who perform LLIF. Results The lateral access training model (LATM) features the following three components: torso casing, spine module, and IONM feature. This model utilizes operable ABS (acrylonitrile butadiene styrene) 3D-printed lumbar vertebrae, verified for anatomical accuracy and compatibility with fluoroscopy. Additionally, a novel neuromonitoring simulation algorithm was developed to train junior residents on neurological complications. To further highlight the need for lateral training models, 30/30 polled surgeons felt that this simulator has value for the field, 29/30 noted that they would have used the LATM if they had access during training, and 30/30 responded that they would encourage trainees to practice on the LATM. Conclusion The LATM is a first step to provide reliable and inexpensive basic lateral lumbar spine training. While this model is lacking some anatomical features, our simulator offers novel training elements for lateral lumbar transpsoas approaches, which lay the foundation for future models to be built. The need for this training exists, and current gaps in the approach to learning these complex techniques need to be filled due to the inconvenience, cost, and impracticability of standard cadaveric models.

show abstract

Lateral Lumbar Interbody Fusion (LLIF): An Update

Cited by 30 publications

References 22 publications

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Creation of a Proof-of-Concept 3D-Printed Spinal Lateral Access Simulator

Contact Info

Product

Resources

About