Safety Analysis of Two Anterior Lateral Lumbar Interbody Fusions at the Initial Stage of Learning Curve

Li, Jiaqi; Wang, Xianzheng; Sun, Yapeng; Zhang, Fei; Gao, Yuan; Li, Zeyang; Ding, Wenyuan; Shen, Yong; Zhang, Wei

doi:10.1016/j.wneu.2019.03.294

Cited by 21 publications

(31 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2017, Shunsuke Fujibayashi et al [15] reported one major vascular injury. In 2019, Jiaqi Li et al [16] reported 3 cases of vascular injury. Therefore, for the spine surgeon, careful operation during surgery and mastery of the anatomy are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…On these three levels, there were a few subjects with the zone IL and Ac. These two kinds of interspace between left psoas muscle and major artery seemingly offer a compact and severe OLIF working corridor, especially for young surgeons who are in the early stages of the learning curve of OLIF approach [16]. On the contrary, patients in zone IIR and IIa provide a wider natural working corridor and theoretically decrease the rate of approach-related intraoperative complication [12,18,22].…”

Section: Discussionmentioning

confidence: 99%

“…Shunsuke Fujibayashi et al [15] reported 1 case of major vascular injury and 7 cases of segmental artery injury in 992 patients. Jiaqi Li et al [16] reported 3 cases of vascular injury in 30 patients. Despite the above research that the probability of major vascular (abdominal aorta or iliolumbar vessel) injury is very small, this type of injury is almost fatal.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The OLIF working corridor based on magnetic resonance imaging: a retrospective research

Wang

Liu

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Objective: To provide an anatomical basis for the development of oblique lumbar interbody fusion (OLIF) in Chinese patients. Methods: Between November 2018 and June 2019, 300 patients' lumbar MRI data were reviewed. According to the Moro system and zone method described by us, the axial view was vertically divided into 6 zones (A, I II, III, IV, P) and was horizontally divided into 4 zones (R, a, b, c, L). The locations of left psoas muscle and the major artery at L2/3, L3/4, and L4/5 levels were evaluated by the grid system. The aortic bifurcation segments will also be evaluated at the level of the vertebral body or the disc. Results: At the L2/3 level, left psoas muscle and the major artery in zone Ib were found in 28.0% of subjects, in zone IIb in 20.3%, and in zone Ic in 20.0%; at the L3/4 level, in zone Ab in 20.7% of subjects, in zone Ac in 26.0%, and in zone Ic in 11.0%; and at the L4/5 level, areas in zone Ab in 31.0% of subjects, in zone Ac in 26.0%, and in zone Ib in 11.7%. The aortic bifurcation segments were mainly at the L4 level. The zone of the left psoas muscle at all levels, the zone of the major artery at L4/5 level, and the zone of the aortic bifurcation segments had significant correlation with gender difference (P < 0.05). Conclusion: The left-sided OLIF at L2-L5 disc levels can be a feasible type of surgery for lumbar interbody fusion in the majority of Chinese patients. Before the operation, in order to screen out the appropriate surgical approach, routine lumbar magnetic resonance imaging is recommended to analyze the patient's local anatomical features.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The OLIF working corridor based on magnetic resonance imaging: a retrospective research

Wang

Liu

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…These advantages help beginners gain easier access, thereby lowering the risk of intraoperative musculoligamentous injury or bleeding. We can predict that the learning curve for OLIF might be short; however, information related to this is lacking [ 3 , 20 ]. Hence, our consecutive cases could show the learning curve for complications as well as changes in operation time and estimated blood loss (EBL).…”

Section: Introductionmentioning

confidence: 99%

Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

Son

Lee

et al. 2021

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. Methods : This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. Results : Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. Conclusion :According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.

show abstract

“…Further, XLIF/MIS XLIF uniquely contributed to multiple new major neurological injuries(10%-40%) to the lumbar plexus, ilioinguinal, iliohypogastric, genitofemoral, lateral femoral cutaneous, and subcostal nerves [Tables 1 and 2]. [10,11,5-7,14,24] These resulted in; new sensory deficits (0-75% (21.7%-40%); permanent 62.5%); new motor deficits (0.7-40%; most typically iliopsoas weakness (9%-31%: 5%)), sympathectomy (4%), and anterior thigh/groin pain (12.5%-34%). [10,11,5-7,14,24] Further multiple non-neurological complications included; subsidence (10.3%-13.8%), failure to adequately decompress stenosis, major vascular injuries (0.4%), bowel perforations, postoperative ileus, recurrent seroma, pseudarthrosis (7.5%), and malpositioning of XLIF cages including a 45% risk of cage-overhang.…”

Section: Introductionmentioning

confidence: 99%

Review of Risks and Complications of Extreme Lateral Interbody Fusion (XLIF)

Epstein¹

2019

Surgical Neurology International

View full text Add to dashboard Cite

Background: Extreme lateral interbody fusions (XLIF) and Minimally Invasive (MIS) XLIF were developed to limit the vascular injuries associated with anterior lumbar interbody fusion (ALIF), and minimize the muscular/ soft tissue trauma attributed to transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). Methods: Nevertheless, XLIF/MIS XLIF pose significant additional risks and complications that include; multiple nerve injuries (e.g. lumbar plexus, ilioinguinal, iliohypogastric, genitofemoral, lateral femoral cutaneous, and subcostals (to the anterior abdominal muscles: abdominal oblique), and sympathectomy), major vascular injuries, bowel perforations/postoperative ileus, seromas, pseudarthrosis, subsidence, and reoperations. Results: The risks of neural injury with XLIF/MIS XLIF (up to 30-40%) are substantially higher than for TLIF, PLIF, PLF, and ALIF. These neural injuries included: lumbar plexus injuries (13.28%); new sensory deficits (0-75% (21.7%-40%); permanent 62.5%); motor deficits (0.7-33.6%-40%); iliopsoas weakness (9%-31%: permanent 5%), anterior thigh/groin pain (12.5-34%), and sympathectomy (4%-12%). Additional non-neurological complications included; subsidence (10.3%-13.8%), major vascular injuries (0.4%), bowel perforations, recurrent seroma, malpositioning of the XLIF cages, a 45% risk of cage-overhang, pseudarthrosis (7.5%), and failure to adequately decompress stenosis. In one study, reviewing 20 publications and involving 1080 XLIF patients, the authors observed “Most (XLIF) studies are limited by study design, sample size, and potential conflicts of interest.” Conclusion: Many new neurological deficits and other adverse events/complications are attributed to MIS XLIF/ XLIF. Shouldn’t these significant risk factors be carefully taken into consideration before choosing to perform MIS XLIF/XLIF?

show abstract

Safety Analysis of Two Anterior Lateral Lumbar Interbody Fusions at the Initial Stage of Learning Curve

Cited by 21 publications

References 27 publications

The OLIF working corridor based on magnetic resonance imaging: a retrospective research

The OLIF working corridor based on magnetic resonance imaging: a retrospective research

Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

Review of Risks and Complications of Extreme Lateral Interbody Fusion (XLIF)

Contact Info

Product

Resources

About