Risks of Colon Injuries in Extreme Lateral Approaches to the Lumbar Spine: An Anatomical Study

Yılmaz, Emre; Iwanaga, Joe; Moisi, Marc; Blecher, Ronen; Abdul-Jabbar, Amir; Tawfik, Tamir; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.7759/cureus.2122

Cited by 9 publications

(11 citation statements)

References 22 publications

(20 reference statements)

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“…However, LLIF may not be adequate in patients with severe central stenosis, previous retroperitoneal surgery, or abnormal neurovascular anatomy [42, 43]. LLIF can achieve deformity correction with large interbody implants and high fusion rates [15, 60], although these come with heightened risks of vascular injury or injury to the psoas muscle, lumbar plexus, or bowel [3, 5, 21, 35, 40, 76]. As with ALIF, LLIF can provide an anterior strut but requires a secondary posterior procedure to attain 360° support and reduce the risk of graft subsidence [2, 7].…”

Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

2020

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Background Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height. Questions/Purposes We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine. Methods Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review. Results Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK–titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation. Conclusions All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.

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Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

2020

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“…An anatomical study evaluating the risk of colon injury in extreme lateral approaches to the lumbar spine indicated the presence of a high risk of colon injury at the L2–3 and L3–4 levels [ 13 ]. In the current study, the incidence of pneumoperitoneum and/or bowel injury was significantly high when the L2–3 level was included in the LLIF surgery.…”

Section: Discussionmentioning

confidence: 99%

Bowel Injury and Insidious Pneumoperitoneum after Lateral Lumbar Interbody Fusion

et al. 2022

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Retrospective review of prospectively collected cases. Purpose: To report bowel injury cases and determine the incidence and risk factors of insidious pneumoperitoneum after lateral lumbar interbody fusion (LLIF). Overview of Literature: Minimally invasive LLIF is considered a safe surgical approach with a low risk of complications. Visceral injury after LLIF is rare and, to our knowledge, no studies on pneumoperitoneum after LLIF have been performed. Bowel injury is a catastrophic complication, but the clinical signs may not be apparent. After we encountered two cases of bowel injury after LLIF, we decided to perform computed tomography of the abdomen and pelvis (APCT) after surgery for all patients who underwent LLIF. Methods: A total of 90 patients underwent APCT within 48 hours of surgery. Medical records were reviewed to determine each patient's age, sex, body mass index, medical and surgical histories, characteristics of LLIF procedures, and subjective symptoms and abnormal findings in the physical examination related to acute abdomen after surgery. Various parameters were compared between patients with and without pneumoperitoneum. Results: Bowel injuries were identified in the first two patients and five patients (5.5%) were diagnosed with pneumoperitoneum only on APCT. We found that the greater the number of fused segments, the higher the incidence of postoperative bowel injury and/or pneumoperitoneum. The incidence was significantly high when the L2-3 level was included in the LLIF surgery. Conclusions: Pneumoperitoneum after LLIF indicates damage to the peritoneum and the presence of bowel injury that may lead to peritonitis. However, it is difficult to distinguish pneumoperitoneum and/or bowel injury from general abdominal pain after surgery because patients may present with a wide range of symptoms. We recommend that APCT be routinely performed after LLIF surgery in order to promptly identify pneumoperitoneum and bowel injury.

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“…The lumbar sympathetic trunk is connected to the ventral ramus of the lumbar spinal nerves via the gray and white rami communicantes and usually contains four interconnected ganglia sitting in the extraperitoneal connective tissue on the anterolateral surface of the lumbar vertebrae along the medial border of the psoas muscle found the disc spaces at L2-L3 and L3-L4 to be the levels at which the lumbar sympathetic ganglia were usually located, an area where anatomical variations are frequent [8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Deviation of the dissection plane into the retroperitoneum or peritoneum entails a risk of injury to urinary and gastrointestinal tract structures, and targeting of the more caudal vertebrae and disc spaces entails a greater risk of injury to the lumbar and lumbosacral plexuses if not accounted for during pre-operative planning [2][3][4]. Therefore, anatomical studies are continuing to seek ways of minimizing the risk of injury [5][6][7][8]. As with any surgery, complex minimally invasive spinal surgery necessitates strong anatomical knowledge in addition to technical capability [1].…”

Section: Introductionmentioning

confidence: 99%