Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

Abstract

Object In this study the authors report on the clinical outcomes, safety, and efficacy of lateral retroperitoneal transpsoas minimally invasive surgery–lumbar interbody fusion (MIS-LIF) at the L4–5 disc space in patients with spondylolisthesis. This approach has become an increasingly popular means of fusion. Its most frequent complication is lumbar plexus injury. Reported complication rates at the L4–5 disc space vary widely in the literature, bringing into question the safety of MIS-LIF for the L4–5 region, especially in patients with spondylolisthesis. Methods The authors retrospectively reviewed prospectively acquired multicenter databases of patients with Grade I and II L4–5 spondylolisthesis who had undergone elective MIS-LIF between 2008 and 2011. Clinical follow-up had been scheduled for 1, 3, 6, 12, and 24 months postoperatively. Outcome measures included estimated blood loss, operative time, length of hospital stay, integrity of construct, complications, fusion rates, visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36). Results Eighty-four patients with L4–5 MIS-LIF were identified, 31 of whom met the study inclusion criteria: 26 adults with Grade I and 5 adults with Grade II L4–5 spondylolisthesis who had undergone elective MIS-LIF and subsequent posterior percutaneous pedicle screw fixation without surgical manipulation of the posterior elements (laminectomy, foraminotomy, facetectomy). The study cohort consisted of 9 males (29%) and 22 females (71%) with an average age of 61.5 years. The mean total blood loss was 94 ml (range 20–250 ml). The mean hospital stay and follow-up were 3.5 days and 18.2 months, respectively. The average score on the ODI improved from 50.4 preoperatively to 30.9 at the last follow-up (p < 0.0001). The SF-36 score improved from 38.1 preoperatively to 59.5 at the last follow-up (p < 0.0001). The VAS score improved from 69.9 preoperatively to 38.7 at the last follow-up (p < 0.0001). No motor weakness or permanent deficits were documented in any patient. Correction of deformity did not have any neurological complications. All patients had improvement in anterolisthesis. Residual postoperative listhesis across cases was noted in 4 patients (12.9%). Transient anterior thigh numbness (Sensory Dermal Zone III) was noted in 22.5% of patients. Conclusions With its established surgical corridors through the retroperitoneum and psoas muscle, the MIS-LIF combined with posterior percutaneous pedicle screw fixation/reduction is a safe, reproducible, and effective technique for patients with symptomatic degenerative spondylolisthesis at the L4–5 vertebral segment.

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

“…2,3,7,9,11,12,17,21,24 No serious neurological complications occurred in any patients in the current study, but the incidence of neurological complications of 38.9% in the conventional group was comparatively high, as also seen in past reports. In contrast, the rate of neurological complications of 13% (5 in 36 patients) in the finger electrode group was significantly lower than that in the control group.…”

“…[1][2][3]9,12,[16][17][18]21,24 Reduction of neurological complications is likely to improve the surgical outcome of XLIF and expand the indication. For this reason, we developed a new neural monitoring system using a finger electrode to reach the intervertebral region in patients undergoing XLIF.…”

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

“…-0 1 -0% ---Lykissas et al [31] 295 ± 180 ---135% ---Grimm et al [32] 122 -181 -20% -3.0 -Tohmeh et al [33] ----48% ---Berjano et al [34] ----16% ---Lee et al [26] 52 ± 19 -0 [35] 73 ± 31 -< 50 -29% ---Sharma et al [36] ----70% ---Pimenta et al [25] 130 ---28% -1.4 -Ahmadian et al [37] --94 ---3.5 -Caputo et al [38] ----2 ---Malham et al [39] 84 -70 -20% ---Pimenta et al [40] 69 ± 11 -< 50 -13% ---Elowitz et al [41] ----20% 3 ---Oliveira et al [42] cutive, odd/even patient order). In Table 6 [45] polled patients on postoperative day 2, finding a VAS back of 2.2 ± 0.6 in MIS patients and 4.3 ± 0.5, a statistically significant difference (P < 0.05).…”

“…Marchi et al [35] 2012 XLIF PCS Spondylolisthesis 52 -Sharma et al [36] 2011 XLIF RCS Spondylosis ± listhesis, scoliosis 43 -Pimenta et al [25] 2011 XLIF PCS DDD 36 -Ahmadian et al [37] 2013 XLIF RCS L4/L5 spondylolisthesis 31 -Caputo et al [38] 2012 XLIF PCS Scoliosis 30 -Malham et al [39] 2012 XLIF PCS DDD, spondylolisthesis, scoliosis 30 - 4 Pimenta et al [40] 2013 XLIF RCT L4/L5 DDD 30 -Elowitz et al [41] 2011 XLIF PCS LSS 25 -Oliveira et al [42] [27] ----28% 24% --Smith et al [28] 112 ± 31 173 ± 31 90 ± 74 311 ± 370 3% 6% 1.7 ± 1.3 3.6 ± 0.9 Rodgers et al [12] --1.4 g Hb 2.7 g Hb --1.3 5.3 Huang et al [29] 176 ± 8 202 ± 15 572 ± 93 970 ± 209 --11.6 ± 1.3 12.5 ± 1.3 Case series Rodgers et al [13] --1.38 g Hb -1% -1.2 -Ruetten et al [30] …”

Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience

“…Within the literature, the bulk of grade II and highergrade lesions are included as small subsets of larger lateral and anterior MIS surgical cases series, 2,18 with no study other than ours and the aforementioned paper by Rajakumar et al 27 evaluating a cohort limited to patients with higher-grade spondylolistheses. The limited amount of available data may be due not only to the rarity of higher-grade lesions, but also to the reluctance of surgeons to employ an operative strategy that relies on indirect decompression.…”