Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

Sembrano, Jonathan N.; Yson, Sharon C.; Horazdovsky, Ryan D.; Santos, Edward Rainier G; Polly, David W.

doi:10.14444/2016

Cited by 69 publications

(44 citation statements)

References 29 publications

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“…ALIF, TLIF, PLIF, and PLF) (e.g., greater end plate/disc removal, restoration of sagittal balance and/or lordosis, but early cage settling) [ Table 1 ]. [ 12 22 26 27 ] Tatsumi et al . found that for four fusions (ALIF, PLIF, TLIF, and XLIF) performed in 8 cadavers (24 disc spaces and 48 end plates from L2-L5), MIS XLIF provided the most extensive end plate preparation (58.3%) and disc removal (90%), whereas less disc was removed for the other constructs (e.g.…”

Section: Pros and Cons Of Xlif: X-ray/computed Tomography (Ct) And Bimentioning

confidence: 99%

“…noted on standing pre and 6-week postoperative X-rays (147 patients; 212 levels fused), that all constructs demonstrated comparable improvement in sagittal balance, but that ALIF provided better segmental/general correction. [ 22 ] For Tohmeh et al ., 140 patients undergoing MIS XLIF/pedicle screw fixation at 223 levels (followed for 15.5 postoperative months), despite increases in overall lordosis (4.0 to 8.1) and segmental lordosis (10.7 to 13.7), cage settling (e.g. >1 mm or more) occurred in 20% of patients immediately postoperatively and in 62% of the patients within 1 postoperative year.…”

Section: Pros and Cons Of Xlif: X-ray/computed Tomography (Ct) And Bimentioning

confidence: 99%

“…[ 8 18 20 ] Cons, however, included a high risk for neurological injury and general complications, along with graft/cage settling (e.g., 20% immediately, 62% at one year). [ 12 22 26 27 ]…”

Section: Pros and Cons Of Xlif: X-ray/computed Tomography (Ct) And Bimentioning

confidence: 99%

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Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

Epstein

2016

Surg Neurol Int

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Background:Major factors prompted the development of minimally invasive (MIS) extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USE) for the thoracic/lumbar spine. These include providing interbody stabilization and indirect neural decompression while avoiding major visceral/vessel injury as seen with anterior lumbar interbody fusion (ALIF), and to avert trauma to paraspinal muscles/facet joints found with transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterior-lateral fusion techniques (PLF). Although anticipated pros of MIS XLIF included reduced blood loss, operative time, and length of stay (LOS), they also included, higher fusion, and lower infection rates. Unanticipated cons, however, included increased morbidity/mortality rates.Methods:We assessed the pros and cons (e.g., risks, complications, comparable value/superiority/inferiority, morbidity/mortality) of MIS XLIF vs. ALIF, TLIF, PLIF, and PLF.Results:Pros of XLIF included various biomechanical and technical surgical advantages, along with multiple cons vs. ALIF, TLIF, PLIF, and PLF. For example, XLIF correlated with a considerably higher frequency of major neurological deficits vs. other constructs; plexus injuries 13.28%, sensory deficits 0–75% (permanent in 62.5%), motor deficits 0.7–33.6%, and anterior thigh pain 12.5–25%. XLIF also disproportionately contributed to other major morbidity/mortality; sympathectomy, major vascular injuries (some life-ending others life-threatening), bowel perforations, and seromas. Furthermore, multiple studies documented no superiority, and the potential inferiority of XLIF vs. ALIF, TLIF, PLIF, and PLF.Conclusion:Reviewing the pros of XLIF (e.g. radiographic, technical, biomechanical) vs. the cons (inferiority, increased morbidity/mortality) vs. ALIF, TLIF, PLIF, and PLF, we question whether XLIF should remain part of the lumbar spinal surgical armamentarium.

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Section: Pros and Cons Of Xlif: X-ray/computed Tomography (Ct) And Bimentioning

confidence: 99%

Section: Pros and Cons Of Xlif: X-ray/computed Tomography (Ct) And Bimentioning

confidence: 99%

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Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

Epstein

2016

Surg Neurol Int

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“…For patients with ASD and mild to moderate global sagittal imbalance (sagittal vertical axis [SVA] less than 10 cm), 26 surgical strategies are widely varied according to surgeon preference for interbody fusion, adaptation of minimally invasive surgical technique, and type of deformity. 14,23,27 In an attempt to decrease blood loss, minimize softtissue dissection, and improve recovery times after ASD operations, minimally invasive surgical approaches have gained popularity in this arena. Although concerns have been raised regarding the ability of these approaches to correct sagittal plane deformity, the evolution of instrumentation for minimally invasive surgeries has broadened their applicability.…”

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confidence: 99%

Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance

Bae

Theologis²,

Strom³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVESurgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)–only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF).METHODSThe medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years’ follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were −1.2 (VAS back pain), −1.6 (VAS leg pain), −15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary).RESULTSA total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence–lumbar lordosis (LL) mismatch of > 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence–LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score.CONCLUSIONSSatisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.

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“…Finally, the aim of this surgical correction was to correct spondylolisthesis; therefore, the reduction in the distance of slippage and restoration of HOD was necessary. The TLIF procedure has been widely accepted since 1998 and is able to improve HOD effectively (27,30,37). In the present study, unlike SD, HOD demonstrated a significant correlation with some of the sagittal spinopelvic parameters.…”

Section: Statisticsmentioning

confidence: 41%

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Chumnanvej

Segkhaphant²

2018

Turkish Neurosurgery

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be elucidated (1,7,33). Thus, the objective parameters such as spinopelvic parameters are required (9,11,29). Since spinopelvic parameters are intricately associated with the deformity, changes in spinopelvic parameters can be objectively determined after correction of the deformity (10,17,23,25,28,38). Several studies have proposed methods for determination of spinopelvic parameters after surgical correction for DLS (2-5,

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Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

Cited by 69 publications

References 29 publications

Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

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