Minimally invasive lateral lumbar interbody fusion and transpsoas approach–related morbidity

Moller, David J.; Slimack, Nicholas P.; Acosta, Frank L.; Koski, Tyler R.; Fessler, Richard G.; Liu, John C.

doi:10.3171/2011.7.focus11137

Cited by 141 publications

(86 citation statements)

References 23 publications

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“…In a review summarizing 18 studies with a total of 2310 patients, 304 patients had complications related to lumbar plexus injury representing a 13% risk [2] despite intraoperative neuromonitoring. Although many of these complications were reported as transient, persisting neurologic symptoms might occur in different intensity in as much as 18% [15,25,33,46]. Because the access corridor is transmuscular for this technique, intramuscular preparation is likely the main underlying reason for the abovedescribed nerve root injury.…”

Section: Discussionmentioning

confidence: 99%

“…However, even with neuromonitoring there is a high risk of approach-related neurologic and muscular complications. The risk of postoperative hip flexor and quadriceps weakness, which are considered to be approach-related muscular trauma, range between 20% and 36%, whereas sensory deficits and anterior thigh pain range between 25% and 75% and 23% and 60%, respectively [15,20,25,33,43,46].…”

Section: Introductionmentioning

confidence: 99%

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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

134

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

134

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“…14,21,33 The transpsoas approach does, however, pose risk to neural structures of the lumbar plexus as they course through the psoas. 2,12,13,15,21 The large muscle belly of the psoas and overlap of the iliac crest make access to the L4-5 disc difficult and eliminate access to the L5-S1 disc.…”

mentioning

confidence: 99%

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

Davis

Hynes²,

Fung

et al. 2014

SPI

163

145

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Object Access to the intervertebral discs from L2–S1 in one surgical position can be challenging. The transpsoas minimally invasive surgical (MIS) approach is preferred by many surgeons, but this approach poses potential risk to neural structures of the lumbar plexus as they course through the psoas. The lumbar plexus and iliac crest often restrict the L4–5 disc access, and the L5–S1 level has not been a viable option from a direct lateral approach. The purpose of the present study was to investigate an MIS oblique corridor to the L2–S1 intervertebral disc space in cadaveric specimens while keeping the specimens in a lateral decubitus position with minimal disruption of the psoas and lumbar plexus. Methods Twenty fresh-frozen full-torso cadaveric specimens were dissected, and an oblique anatomical corridor to access the L2–S1 discs was examined. Measurements were taken in a static state and with mild retraction of the psoas. The access corridor was defined at L2–5 as the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 corridor of access was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel and vertically to the first vascular structure that crosses midline. Results The mean access corridor diameters in the static state and with mild psoas retraction, respectively, were as follows: at L2–3, 18.60 mm and 25.50 mm; at L3–4, 19.25 mm and 27.05 mm; and at L4–5, 15.00 mm and 24.45 mm. The L5–S1 corridor mean values were 14.75 mm transversely, from midline to the left common iliac vessel and 23.85 mm from the inferior endplate of L-5 cephalad to the first midline vessel. Conclusions The oblique corridor allows access to the L2–S1 discs while keeping the patient in a lateral decubitus position without a break in the table. Minimal psoas retraction without significant tendon disruption allowed for a generous corridor to the disc space. The L5–S1 disc space can be accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2–S1 discs.

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“…The indirect decompressive effect of LLIF results in disc height restoration and reduction in the occurrence of spondylolisthesis. 10,12,13 The restoration of disc height induces foraminal widening and a ligamentotaxis effect of disc bulging. However, central stenosis by hypertrophied ligamentum flavum and ruptured disc herniation cannot be decompressed by LLIF.…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive lateral lumbar interbody fusion (LLIF) surgeries, such as direct lateral interbody fusion (DLIF) and oblique lumbar interbody fusion (OLIF), have been attempted recently to treat lumbar degenerative disease. 5,6,10,17 Compared with posterior lumbar interbody fusion or TLIF, LLIF cannot result in direct decompression as is seen in posterior fusion surgery. Indirect decompression effects caused by reduction of spondylolisthesis and disc space widening, as with ALIF, are observed with LLIF.…”

mentioning

confidence: 99%

Clinical and radiological outcomes of spinal endoscopic discectomy–assisted oblique lumbar interbody fusion: preliminary results

Heo

Kim

2017

Neurosurgical Focus

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OBJECTIVEDirect neural decompression cannot be achieved by performing lateral lumbar interbody fusion (LLIF). To overcome the indirect decompressive effect of LLIF, additional endoscopic discectomy with oblique lumbar interbody fusion (OLIF) has been attempted. The purpose of this study was to assess the clinical and radiological outcomes of patients who underwent OLIF with additional endoscopic discectomy.METHODSSpinal endoscopic discectomy–assisted OLIF was attempted to remove herniated disc material. Only patients with a follow-up time that exceeded 12 months were enrolled. Clinical parameters examined were the Oswestry Disability Index and visual analog scale scores of back and leg pain. Postoperative MRI was also performed.RESULTSFourteen patients were enrolled. Central and foraminal disc herniations were evident in 8 and 6 patients, respectively. Concomitant central or foraminal herniated discs were removed completely after additional endoscopic discectomy, and disc removal was confirmed by postoperative MRI. Mean preoperative visual analog scale scores and Oswestry Disability Index scores improved postoperatively.CONCLUSIONSOLIF with additional endoscopic discectomy results in successful direct neural decompression without posterior decompressive procedures. Endoscopic assistance might overcome the limitations of LLIF.

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Minimally invasive lateral lumbar interbody fusion and transpsoas approach–related morbidity

Cited by 141 publications

References 23 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

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

Clinical and radiological outcomes of spinal endoscopic discectomy–assisted oblique lumbar interbody fusion: preliminary results

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