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L4-L5 degenerative spondylolisthesis. XLIF plus percutaneous unilateral pedicle-screw fixation. At 12 months, interbody fusion is evident with preservation of lordosis. Excellent clinical result
Source publication
To describe the clinical outcomes and complications in a consecutive series of extreme lateral interbody fusion cases.
Retrospective cohort review of 97 consecutive patients from three centers with minimum 6-month follow-up (mean 12 months). Functional status was evaluated by preoperative and last follow-up Oswestry Disability Index score. Leg and...
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Citations
... In an elderly person with stenosis due to D 1 A 0 L 0 F 3 (2%), posterior decompression and interspinous/ interlaminar dynamic stabilization may be a preferred minimally invasive option [21]. Currently, the commonly used MIS options for decompression, fusion, and instrumentation include MIS-Transforaminal lumbar interbody fusion, direct lateral lumbar interbody fusion, pre-sacral interbody fusion and interlaminar fusion and instrumentation [22][23][24][25][26][27][28]. ...
Background: Multiple minimally invasive spine approaches and techniques have been developed in recent years. While the disease processes affecting the spinal motion-segment (SMS) have remained largely the same, surgical treatment options have changed radically and not necessarily in an organized fashion. This is inevitable given the rapid evolution of the technology. The current image-based diagnostic techniques, also evolving, have helped us appreciate the disease Patho anatomy in minute detail. A comprehensive classification method accounting for all anatomical participants in the spinal motion-segment pathology, tailored to treatment options, is necessary. Out of the many valid options, a spine surgeon should be able to choose a single surgical approach that is most appropriate for the Patho anatomy of his/her patient’s disease. We feel that our classification system will help the spine surgeon make that important decision consistently, with minimal risk of leaving behind a significant lesion, or disrupting a structure which is not a participant in the disease process. Furthermore, universal acceptance of this classification system will make it easier for spine surgeons to communicate with each other and meaningfully compare the results of the various surgical approaches. Purpose of the Study: To develop a comprehensive, treatment-orientated classification of lumbar spinal motion-segment disease. Materials and Methods: Contributors to spinal motion-segment disease - intervertebral disc, facet joint, ligamentum flavum and mal-alignment were identified. The degrees of abnormalities in each of these entities were coded, and the codes were entered in a table from which the possible combinations of pathologic processes were generated. Study of 57 lumbar MRI images (217 spinal motion-segments) was carried out to determine the prevalence of various combinations of the motion-segment disease. Pre- and post-operative MRI-based spinal motion-segment classifications were performed to evaluate the clinical application of this classification system in 15 patients. Results: This classification presents 494 possible combinations of the spinal motion-segment disease. Many of the combinations are only theoretical possibilities without clinical significance. Normal motion-segments, D0 A0 L0 F0 , represented 33.3% of the total motion-segments; D1 A0 L0 F0 was 8.8%, representing bulging disc, normal alignment, ligamentum flavum and facet joint. D2 A0 L0 F2 was 6.9% representing intraannular disc herniation, normal alignment, mildly thickened ligamentum flavum, and hypertrophied superior articular process of the facet joint. 6.4% was D1 A0 L1 F3 representing bulging disc, mildly hypertrophic ligamentum and hypertrophied facet joint. Clinical application of the classification revealed: Accurate anatomic classification; immediate post-operative classification changes which correlate with patient’s symptoms; pre-operative, immediate post-operative and late post-operative classifications which correlate with patient’s symptoms and accurately demonstrate post-operative remodeling of the motion-segment, especially after disc surgery, and accurate; and anatomic documentation of pre- and post op classifications of interlaminar endoscopic decompression. Conclusion: A treatment-orientated, standardized classification of spinal motion-segment disease is necessary considering current multiple treatment options and availability of sophisticated pre-operative imaging techniques. Such a classification will allow standardization of treatment options for various combinations of the pathological processes. With the emergence of new technologies surgical options can be upgraded based on a standardized classification. This in turn will help minimize confusion for those who want to learn and facilitate growth in the minimally invasive technology. The preliminary results of clinical application of the classification showed it to be a very accurate patho-anatomic representation; immediate post-operative classification change reflected clinical improvement post-operatively; and precise representation of post-operative remodeling of the motion-segment one to two years post-operatively. The precision of this classification allows accurate communication regarding the pathology, between providers across the globe, and more accurate comparison of results of different surgical interventions.
... Moreover, postoperative complication rates were higher in the PLIF than in the OLIF group (OR = 0.46), and patients receiving PLIF more often had serious complications such as Iatrogenic nerve root injury compared to those receiving OLIF. Although the overall postoperative complication rate was lower in the OLIF group, this group had a higher risk of specific complications such as retrograde ejaculation and abdominal aortic injury compared to the PLIF group [34,39]. Therefore, some scholars question the safety of OLIF, speculating that avoiding large vessels during operation will increase the risk of massive bleeding during operation and affect the recovery of patients [31,40]. ...
Background
Although oblique lumbar interbody fusion (OLIF) has produced good results for lumbar degenerative diseases (LDDs), its efficacy vis-a-vis posterior lumbar interbody fusion (PLIF) remains controversial. This meta-analysis aimed to compare the clinical efficacy of OLIF and PLIF for the treatment of LDDs.
Methods
A comprehensive assessment of the literature was conducted, and the quality of retrieved studies was assessed using the Newcastle–Ottawa Scale. Clinical parameters included the visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain, disability, and functional levels. Statistical analysis related to operative time, intraoperative bleeding, length of hospital stay, lumbar lordosis angle, postoperative disc height, and complication rates was performed. The PROSPERO number for the present systematic review is CRD42023406695.
Results
In total, 574 patients (287 for OLIF, 287 for PLIF) from eight studies were included. The combined mean postoperative difference in ODI and lumbar VAS scores was − 1.22 and − 0.43, respectively. In postoperative disc, height between OLIF and PLIF was 2.05. The combined advantage ratio of the total surgical complication rate and the mean difference in lumbar lordosis angle between OLIF and PLIF were 0.46 and 1.72, respectively. The combined mean difference in intraoperative blood loss and postoperative hospital stay between OLIF and PLIF was − 128.67 and − 2.32, respectively.
Conclusion
Both the OLIF and PLIF interventions showed good clinical efficacy for LDDs. However, OLIF demonstrated a superior advantage in terms of intraoperative bleeding, hospital stay, degree of postoperative disc height recovery, and postoperative complication rate.
... Advances in surgical techniques and instruments have allowed minimally invasive surgical approaches to become a safe alternative to traditional open techniques and often the preferred choice for many spine surgeons. [1][2][3][4][5][6][7] These new minimally invasive approaches mainly include anterior intervertebral lumbar fusion (ALIF), lateral/extreme lumbar intervertebral fusion (LLIF/XLIF), and oblique intervertebral lumbar fusion (OLIF/ATP). 8 The OLIF/ATP, which uses the pre-psoas access to the lumbar spine, will be the focus of our study and was first described by Silvestre et al., in 2012. ...
... 14 The lumbar interbody fusion anterior to the psoas is a popular technique within the minimally invasive approaches for spine surgery, with advantages such as minimal bleeding and tissue damage and preservation of the posterior tension band. 1,3,4,15 The surgical corridor allows the placement of inter somatic devices that contribute to increasing disc height and can generate indirect decompression, improving sagittal and coronal alignment and the advantages of a lower risk of lumbar plexus injury. 15 These techniques have specific complications related to the approach. ...
Objective
This study aims to perform a morphometric analysis and explore the characteristics of the surgical corridor of the anterior to psoas approach in the Brazilian population through magnetic resonance imaging (MRI).
Methods
Two hundred spinal MRI scans of patients aged between 18 and 80 years were evaluated using axial cuts at L2-L5 levels and a sagittal cut, T2 weighted. The relationship between the left psoas muscle and the abdominal aorta or the left common iliac artery was analyzed. The anterior to psoas corridor was defined as the shortest distance between the posterolateral aspect of the aorta or inferior vena cava or the nearest iliac vessel and the anteromedial aspect of the ipsilateral psoas muscle.
Results
104 females and 96 males with a mean age of 49,68±2.04 (range 18–80) years. The mean anterior to psoas distance at the L2-L3 level was 14,17±0.75mm; at the L3-L4 level was 12,08±0.77m,m and at the L4-L5 level was 9,12±0.77mm. The surgical corridors at all levels were larger in the older population.
Conclusion
In most Brazilian patients, the anterior to psoas approach can be a good alternative for lumbar intervertebral fusions. As a routine in preoperative examination and surgical planning, lumbar MRI is fundamental in preoperative evaluation for anterior to psoas approach surgery. Level of Evidence IV; Descriptive study.
Keywords:
Spine; Magnetic Resonance; Back pain
... LLIFs are a popular lumbar fusion technique due to its ability to optimize sagittal alignment, while avoiding manipulation of the great vessels anteriorly. [14][15][16][17] The minimally invasive nature of the surgery allows for shorter overall hospital length of stay when compared to open surgeries. [18] When compared to similar minimally invasive fusions such as oblique lateral interbody fusion, LLIF has been shown to be safer for new surgeons due to a lower learning curve. ...
Context: Abdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear.
Aims: To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF.
Settings and Design: This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals.
Materials and Methods: Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two groups depending on whether they received a postoperative abdominal radiograph or computed tomography (CT) scan for postoperative abdominal pain.
Statistical Analysis: Patient demographics, surgical characteristics, and surgical outcomes were compared between groups utilizing independent t-tests or Mann–Whitney U-tests for continuous variables or Pearson's Chi-square tests for categorical variables.
Results: A total of 153 patients (18 with abdominal scans, 135 without) were included. Patients who received a postoperative abdominal radiograph or CT scan were more likely to undergo exploratory laparotomy (11.1% vs. 0.00%, P = 0.013). Ultimately, patients with abdominal scans had a longer hospital length of stay (6.67 vs. 3.79 days, P = 0.002) and were discharged home less frequently (71.4% vs. 83.7%, P = 0.002).
Conclusions: Patients who received abdominal imaging after LLIF were more likely to undergo exploratory laparotomy, experience longer hospital length of stay, and were discharged home less frequently. Intra-abdominal air on postoperative imaging without corresponding physical exam findings consistent with bowel injury is not an appropriate indication for surgical intervention.
... The sacrifice of L3 right nerve root did not result in a significant loss of function of the quadriceps, which returned to normal function few weeks after surgery. The literature on trans-psoas anterior interbody fusion suggests that the approach can cause dysfunction of the muscles and nerves [24,25], leading to weakness of the hip flexors and potential damage to the lumbar plexus. In this case, the psoas muscle was completely transected on the left side. ...
Introduction
To fulfill oncological criteria, extensive open anterior and posterior approaches are usually performed in the lumbar spine to obtain an appropriate en-bloc spondylectomy. It is commonly accepted that the price of a tumor-free margin includes such extensive incisions and soft-tissue damage, with consequent relevant blood loss and possible postoperative complications as delayed wound healing. In this article, a case of chordoma in L3 is presented, submitted to an oncologically appropriate en-bloc resection performed by an open posterior approach combined with a mini-retroperitoneal approach. The successful oncologic procedure was combined with a short and uneventful postoperative course.
Materials and methods
The authors present the surgical technique and the possible challenges of minimally invasive anterior oncologic surgery as a contribution to a limited literature.
Results
Up to date, palliative care of single metastases has been the main setting in which anterior, minimally invasive surgery has been performed in the lumbar spine. The authors explained how, in selected cases, this approach can be performed in combination with an open posterior access for an oncologically appropriate treatment of a primary malignant tumor.
Conclusion
Anterior, minimally invasive surgery can have a role in selected patients with primary malignant tumors of the lumbar spine. The surgical team should have extensive training both in oncologic and minimally invasive surgery.
... OLIF has several potential advantages, including reduced invasion of the psoas muscle and neural structures, and relatively good access to lower lumbar levels. However, access to the lower lumbar levels is restricted in some cases involving a high-riding pelvis [20][21][22]. Consequently, to perform lumbar interbody fusion from L1 to S1, a separate incision and/or position change are generally required [23]. We have performed lumbar interbody fusion from L1 to S1 without a separate incision or position change by tilting the operating table in a 45˚right oblique decubitus position [24]. ...
... In recent years, with advances in surgical techniques and instrumentation, minimally invasive surgeries have been introduced. In particular, minimally invasive LLIF has been increasingly used as an alternative to ALIF [14,20]. Compared to ALIF, LLIF can avoid injury to the abdominal viscera and peritoneal penetration, and can reduce the risk of injury to the great vessels, including the common iliac vein, inferior vena cava, and iliolumbar vein, as well as the sympathetic chain [24,26]. ...
... In some of our cases, lumbar interbody fusion from L1 to S1 was performed. If access to lower lumbar levels is restricted by a high-riding pelvis, a separate incision and/or position change are required [20][21][22][23][24]. However, we performed lumbar interbody fusion from L1 to S1 without a separate incision or position change by tilting the operating table in the 45˚right oblique decubitus position [24]. ...
Adult spinal deformity (ASD) is usually rigid and requires a combined anterior–posterior approach for deformity correction. Anterior lumbar interbody fusion (ALIF) allows direct access to the disc space and placement of a large interbody graft. A larger interbody graft facilitates correction of ASD. However, an anterior approach carries significant risks. Lateral lumbar interbody fusion (LLIF) through a minimally invasive approach has recently been used for ASD. The present study was performed to evaluate the effectiveness of oblique lumbar interbody fusion (OLIF) in the treatment of ASD. We performed a retrospective study utilizing the data of 74 patients with ASD. The inclusion criteria were lumbar coronal Cobb angle > 20°, pelvic incidence (PI)–lumbar lordosis (LL) mismatch > 10°, and minimum follow–up of 2 years. Patients were divided into two groups: ALIF combined with posterior spinal fixation (ALIF+PSF) ( n = 38) and OLIF combined with posterior spinal fixation (OLIF+PSF) ( n = 36). The perioperative spinal deformity radiographic parameters, complications, and health-related quality of life (HRQoL) outcomes were assessed and compared between the two groups. The preoperative sagittal vertical axis (SVA), LL, PI–LL mismatch, and lumbar Cobb angles were similar between the two groups. Patients in the OLIF+PSF group had a slightly higher mean number of interbody fusion levels than those in the ALIF+PSF group. At the final follow–up, all radiographic parameters and HRQoL scores were similar between the two groups. However, the rates of perioperative complications were higher in the ALIF+PSF than OLIF+PSF group. The ALIF+PSF and OLIF+PSF groups showed similar radiographic and HRQoL outcomes. These observations suggest that OLIF is a safe and reliable surgical treatment option for ASD.
... In recent years, with advancements in surgical techniques and instrumentation, minimally invasive surgical techniques have been introduced. In particular, minimally invasive lateral lumbar interbody fusion has been increasing in popularity as an alternative procedure to ALIF [3,4]. Minimally invasive lateral lumbar interbody fusion is classified into direct lateral interbody fusion (DLIF) and oblique lumbar interbody fusion (OLIF). ...
The aim of this study was to evaluate the effectiveness of OLIF (oblique lumbar interbody fusion) in the treatment of lumbar degenerative spondylolisthesis with sagittal imbalance. Fifty-nine patients were included in our analysis. Included patients were divided into 2 groups according to the surgical techniques: PLIF (posterior lumbar interbody fusion) (n = 31) and OLIF + PSF (OLIF combined with posterior spinal fixation) (n = 28). Perioperative radiographic parameters, complications, and clinical outcome from each group were assessed and compared. The operation time for both groups was 165.1 min in the OLIF group and 182.1 min in the PLIF group (P < 0.05). The intraoperative blood loss was 190.6 ml in the OLIF group and 356.3 ml in the PLIF group (P < 0.05). The number of intraoperative and postoperative complications for both groups was 7 in the OLIF group and 11 in the PLIF group. Significant clinical improvement was observed in VAS scores and ODI when comparing preoperative evaluation and final follow-up. The preoperative SVA (the distance from the posterosuperior corner of S1body to the C7 plumb line), PI (pelvic incidence), LL (lumbar lordosis), PI-LL mismatch, DH (disc height), and lumbar Cobb angles of both groups were similar. The postoperative and final follow-up SVA, LL, PI-LL mismatch, and disc height were improved in both groups, and a statistical difference was found between both groups (P < 0.05). An improvement of SVA, LL, PI-LL mismatch, and disc height at the OLIF group was better than that found at the PLIF group. An improvement in radiographic and clinical outcomes for the OLIF group was better than that seen for the PLIF group. Then, OLIF had a more curative effect in lumbar degenerative spondylolisthesis with sagittal imbalance.
... T he lateral lumbar interbody fusion (LLIF) is a powerful technique for indirect decompression and restoration of segmental alignment while reducing the reproductive, visceral, and vascular risks of the anterior lumbar interbody fusion (ALIF). 1,2 Compared to posterior-approach interbody techniques, the LLIF facilitates placement of larger implants while reducing trauma to paravertebral musculature and avoiding traversing scar in revision cases. 3,4 While stand-alone cage placement has been described for select indications, 3,5 the LLIF is often followed by posterior instrumentation to enhance construct rigidity. ...
... In spine surgery, MIS approaches cover the whole range of procedures [3,4]. The technological advances acquired have allowed the application of different MIS procedures to a wide range of conditions (e.g., fractures, deformities, tumors) [1], but the more common use of MIS is in interbody fusion for the treatment of back pain [5], and sagittal [6] and coronal malalignment correction [7]. Hence, along with the potential benefits for patients, the reliability of MIS procedures in spine surgery relies on the pros and cons. ...
Background:
Different surgical approaches are available for lumbar interbody fusion (LIF) to treat disc degeneration. However, a quantification of their invasiveness is lacking, and the definition of minimally invasive surgery (MIS) has not been biochemically detailed. We aimed at characterizing the inflammatory, hematological, and clinical peri-surgical responses to different LIF techniques.
Methods:
68 healthy subjects affected by single-level discopathy (L3 to S1) were addressed to MIS, anterior (ALIF, n = 21) or lateral (LLIF, n = 23), and conventional approaches, transforaminal (TLIF, n = 24), based on the preoperative clinical assessment. Venous blood samples were taken 24 h before the surgery and 24 and 72 h after surgery to assess a wide panel of inflammatory and hematological markers.
Results:
martial (serum iron and transferrin) and pro-angiogenic profiles (MMP-2, TWEAK) were improved in ALIF and LLIF compared to TLIF, while the acute phase response (C-reactive protein, sCD163) was enhanced in LLIF.
Conclusions:
MIS procedures (ALIF and LLIF) associated with a reduced incidence of post-operative anemic status, faster recovery, and enhanced pro-angiogenic stimuli compared with TLIF. LLIF associated with an earlier activation of innate immune mechanisms than ALIF and TLIF. The trend of the inflammation markers confirms that the theoretically defined mini-invasive procedures behave as such.
... XLIF approach is currently successfully used for the management of several lumbar spine conditions, including degenerative disc disease, degenerative scoliosis, degenerative spondylolisthesis (up to grade 2), non-union of instrumented lumbar fusions, spinal infections (i.e. discitis or osteomyelitis, after active infection treatment), sagittal deformity, junctional disease and total disc replacement revision [3][4][5][6][7][8][9][10][11]. ...
... Compared to open anterior and posterior accesses, the XLIF approach has the advantage of preserving the anterior and posterior longitudinal ligaments [13]. These ligaments have a significant biomechanical role in providing inherent spinal stability, thus enhancing bone formation and fusion [3]. ...
... Furthermore, the XLIF technique has been shown to significantly improve regional, segmental, and global coronal balance in patients with degenerative lumbar disease [3,9,13,17]. It has also revealed a feasible technique for achieving surgical correction, as well as interbody fusion, in adult degenerative scoliosis [6][7][8]. ...
PurposeThe eXtreme Lateral Interbody Fusion (XLIF) approach has gained increasing importance in the last decade. This multicentric retrospective cohort study aims to assess the incidence of major complications in XLIF procedures performed by experienced surgeons and any relationship between the years of experience in XLIF procedures and the surgeon’s rate of severe complications.Methods
Nine Italian members of the Society of Lateral Access Surgery (SOLAS) have taken part in this study. Each surgeon has declared how many major complications have been observed during his surgical experience and how they were managed. A major complication was defined as an injury that required reoperation, or as a complication, whose sequelae caused functional limitations to the patient after one year postoperatively. Each surgeon was finally asked about his years of experience in spine surgery and XLIF approach. Pearson correlation test was used to evaluate the association between the surgeon’s years of experience in XLIF and the rate of major complications; a p-value of last than 0.05 was considered significant.ResultsWe observed 14 major complications in 1813 XLIF procedures, performed in 1526 patients. The major complications rate was 0.7722%. Ten complications out of fourteen needed a second surgery. Neither cardiac nor respiratory nor renal complications were observed. No significant correlation was found between the surgeon's years of experience in the XLIF procedure and the number of major complications observed.ConclusionXLIF revealed a safe and reliable surgical procedure, with a very low rate of major complications, when performed by an expert spine surgeon.
