Minimally Invasive Extreme Lateral Trans-Psoas Approach to the Lumbar Spine: Applications and Techniques

Hood, Brian; Vanni, Steven

doi:10.5772/36813

Cited by 6 publications

(7 citation statements)

References 18 publications

(14 reference statements)

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“…Among them, XLIF has shown an advantage in achieving a better deformity correction (8). XLIF for the treatment of lumbar pathology it was first published in the literature in 2006 (12), and description of the technique, as well as its anatomical details, have been widely described (12)(13)(14)(15). It is a muscle and ligament sparing procedure, allowing, preservation of the spine's stabilizer, including the ALL and posterior osteoligamentous complex (14,15).…”

Section: Discussionmentioning

confidence: 99%

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

et al. 2018

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Background: Surgical treatment of adult degenerative scoliosis (DS) always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. However, the severity of the procedure, in association with the fact that many of these patients are at an advanced age with several comorbidities, results in high rate of complications. Therefore, during the last decade, minimally invasive procedures have gained a place in the treatment of this pathology. Our aim is to determine the safety and efficacy of extra lateral lumbar interbody fusion (XLIF) with or without supplemented instrumentation in the treatment of DS.Methods: In a retrospective case series study, we reviewed the files of patients who underwent XLIF in our Hospital between 2008 and 2017. We recorded the patients' demographic characteristics, clinical parameters such as back-pain [visual analogue scale (VAS)] and back-related disability [Oswestry Disability Index (ODI)], as well as radiological parameters including the Cobb angle. Comparison of the before and after results were performed with the t-test and Chi-square test, where appropriate.Results: Twelve patients fulfilled the eligibility criteria of our study. All patients were female, with a mean age of 64.5 years (SD =7.8 years) and 28 months (SD =13 months) follow-up. The XLIF decreased the pain intensity by 4.66 cm (SD =1.23 cm), and improved the back-related disability by 26% (SD =8.35%) in the ODI scale at the 6-month follow-up. Similarly, scoliosis improved by an average of 11.5° (SD =7°) and lordosis changed by an average of 13.5° (SD =10.86°). All changes were statistically significant. There were three complications, two patients presented meralgia paresthetica, which resolved spontaneously in 3 months, and in one patient occurred an intraoperative bowel perforation treated with bowel anastomosis.Conclusions: XLIF is a feasible and efficient alternative in the treatment of DS. It can be the treatment of choice in elderly patients in whom comorbidities increase the perioperative risk of complications.

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Section: Discussionmentioning

confidence: 99%

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

et al. 2018

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“…The procedure minimized surgical trauma to the patient, used standardized surgical instruments, emphasized good illumination along with the surgical microscope, had minimal blood loss (67.8–168 mL), and decreased operative time (2.0–2.25 hours) [ 4 ]. Importantly, spine surgeons could easily implement this technique as it did not necessitate the learning of methods that were completely foreign to them, nor did it dictate the type of fusion [ 4 , 34 ]. For patients, it provided minimal surgical discomfort, decreased postoperative morbidity, and improved recovery time [ 4 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, spine surgeons could easily implement this technique as it did not necessitate the learning of methods that were completely foreign to them, nor did it dictate the type of fusion [ 4 , 34 ]. For patients, it provided minimal surgical discomfort, decreased postoperative morbidity, and improved recovery time [ 4 , 34 ]. Problems are occasional and primarily involve temporary paresis and dysesthesias in the lower extremities [ 2 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…The minimally invasive retroperitoneal transpsoas lateral approach is becoming more popular among spine surgeons [ 7 , 34 ]. Since its introduction, the technique has been applied to treat multiple spinal disorders including degenerative lumbar disease, spondylosis, spondylolisthesis, deformity, trauma, infection, and tumor [ 34 ]. As such, more and more LIFs are performed along with posterior percutaneous screw fixation.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

Drazin

Kim

Johnson

2015

BioMed Research International

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Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p = 0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

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“…The prevalence of sensory deficits was 1.6%, psoas mechanical deficit was 1.6% and lumbar plexus related deficits was 2.9%, these symptoms were generally resolved in about 6 weeks [13]. Proper patient selection, thorough knowledge of the anatomy, meticulous surgical technique and use of intraoperative monitoring can help avoid or decrease these complications [14].…”

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confidence: 99%

Can XLIF Surgery Treat the Lumbar Spine Infection?

He¹

2014

J Trauma Treat

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Hematogenous vertebral osteomyelitis has increased in recent years, likely due to longer life expectancies, higher prevalence of chronic disease, better diagnostic techniques, and more frequent use of indwelling intravascular catheters and immunosuppressive therapy [1]. Vertebral osteomyelitis represents 2% to 7% of all cases of osteomyelitis and approximately 50% with spine infections are older than 50 years, and two thirds are male [2]. It is associated with significant morbidity, including prolonged antimicrobial therapy, risk of recurrence, and decreased functional status. Staphylococcus aureus is among the most common organisms causing hematogenous vertebral osteomyelitis [1]. Medical management is the first choice to spondylodiscitis, patients who fail antibiotic therapy and bracing, or present with instability, significant deformity, neurologic deficits, or sepsis, were required operative debridement and stabilization [2]. ALIF (anterior lumbar interbody fusion), PLIF (posterior lumbar interbody fusion) and TLIF (transforaminal lumbar interbody fusion) were performed to treat lumbar spondylodiscitis respectively to achieve rather good clinical results but also causing much morbid [3-7].

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Minimally Invasive Extreme Lateral Trans-Psoas Approach to the Lumbar Spine: Applications and Techniques

Cited by 6 publications

References 18 publications

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

Can XLIF Surgery Treat the Lumbar Spine Infection?

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