Two-Year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis. Part II

Isaacs, Robert E.; Sembrano, Jonathan N.; Tohmeh, Antoine

doi:10.1097/brs.0000000000001472

Cited by 73 publications

(112 citation statements)

References 0 publications

Supporting

Mentioning

106

Contrasting

Order By: Relevance

“…T he oblique lateral approach is a muscle-sparing route for cage insertion and the cages used in the OLIF procedure are larger than the counterparts used in the TLIF procedure, which could improve the lumbar alignment to a greater extent 4 . Due to insertion of the large cage, the height of disc space is restored, which results in shrinkage of the bulging disc and flattening of the folded ligamentum flavum.…”

Section: Discussionmentioning

confidence: 99%

“…Oblique lateral interbody fusion (OLIF) is a recently developed minimally invasive surgical technique for degenerative lumbar disorders. It offers several advantages, including less bleeding, achieving indirect decompression, restoring high disc height, and the ability to insert a huge cage, compared with its counterpart, transforaminal lumbar interbody fusion (TLIF). Pedicle screw fixation (PSF) is the most commonly used technique in spinal surgeries including OLIF procedures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L 4–5 level and three segments at L 3–4 level. Two patients had both L 4–5 and L 3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a hig...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…Castellvi et al [12] found that the CCA was improved by 10 mm 2 (27%) and 23 mm 2 (17%) at 3 months and 1 year, respectively, after XLIF. At the 3-month follow-up, Isaacs et al [3] found an increase in the CCA of 20.8 mm 2 and in the CD of 1.2 mm after XLIF. With the exception of the results reported by Elowitz et al [15], the improvement of central canal stenosis in patients with Schizas grade D observed in our study is comparable with those studies [3,11,12].…”

Section: Discussionmentioning

confidence: 96%

“…However, patients with extreme lumbar spinal stenosis are not good candidates for LLIF alone. Stand-alone LLIF is not suggested for such patients, but with concomitant posterior decompression, LLIF can achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis.Although the indirect neural decompression effect of LLIF for lumbar stenosis has been addressed in previous studies[3,4,[9][10][11][12][13], the purpose of the current study was to evaluate the indirect neural decompression effect in patients with extreme lumbar spinal stenosis. The average changes in CD and CCA of grade D were 2.50 ± 1.25 mm and 16.11 ± 10.70 mm 2 , which were comparable with the effects in other grades, and indicated that the indirect decompression effect is not compromised in patients with extreme spinal stenosis.…”

mentioning

confidence: 99%

Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Extreme lumbar spinal stenosis was thought to be a relative contraindication for lumbar lateral interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D. Methods: For radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student's t-test, with P- values < 0.05 considered to indicate statistically significant differences. Results: Among the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression. Conclusion: The radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

show abstract

“…19 Because of its ability to provide indirect decompression without disrupting the posterior elements, segmental stability, and lordosis restoration, the transpsoas LLIF technique has been proposed as a treatment option for DS at L4-5. 1,11,15,25,27 However, concerns exist about the rate of neurological complications associated with the lateral approach. 5,10,14,24 Furthermore, these complications are most conspicuous at the L4-5 level due to the anatomical arrangement of the lumbar plexus with narrower safe working zones more inferiorly in the lower lumbar spine.…”

mentioning

confidence: 99%

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Campbell¹,

Nunley

Cavanaugh³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVERecently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4–5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4–5 level.METHODSThe authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months.RESULTSFifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively.CONCLUSIONSThis study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4–5. The use of this surgical approach provides a minimally invasive solution that offers excellent arthrodesis rates as well as favorable clinical and radiological outcomes, with low rates of postoperative complications. However, adhering to the techniques of transpsoas lateral surgery, such as minimal table break, an initial look-and-see approach to the psoas, clear identification of the plexus, minimal cranial caudal expansion of the retractor, mobilization of any traversing sensory nerves, and total psoas dilation times less than 20 minutes, ensures the lowest possible complication profile for both visceral and neural injuries even in the narrow safe zones when accessing the L4–5 disc space in patients with degenerative spondylolisthesis.

show abstract

Two-Year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis. Part II

Abstract: 2.

Cited by 73 publications

References 0 publications

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Radiographic and clinical outcome of lumbar lateral interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

Contact Info

Product

Resources

About