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Adam S. Kanter and Gurpreet S. Gandhoke

Since its inception in the year 2001 the minimally invasive trans-psoas Lateral Lumbar Interbody Fusion (LLIF) approach has gained significant favor among spine surgeons. It is now routinely utilized to treat an array of spinal pathologies including degenerative disc disease, low grade spondylolisthesis, and adult spinal deformity. The intent of this video is to provide a step by step account of the basic procedural details when performing the LLIF procedure for a single level broad based degenerated lumbar disc with herniation.

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Marco T. Reis, Phillip M. Reyes, BSE, Idris Altun, Anna G. U. S. Newcomb, Vaneet Singh, Steve W. Chang, Brian P. Kelly, and Neil R. Crawford

retroperitoneal surgical approach to the lumbar spine, called lateral lumbar interbody fusion (LLIF), has gained favor as an alternative to achieve fusion, either with or without secondary instrumentation. 1 , 4 , 10 , 11 , 19 , 22 , 26 , 28 , 45 This approach uses advanced lighting and retraction systems to minimize the exposure and soft-tissue damage that occur in the lateral retroperitoneal approach. Relatively few biomechanical studies have evaluated the stability of an interbody fusion construct with and without additional anterior or posterior instrumentation inserted

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Austin Q. Nguyen, Jackson P. Harvey, Krishn Khanna, Bryce A. Basques, Garrett K. Harada, Frank M. Phillips, Kern Singh, Christopher Dewald, Howard S. An, and Matthew W Colman

instrumentation, which requires less dissection than posterolateral fusion and open posterior interbody techniques. At our institution, we often utilize stand-alone interbody devices (anterior lumbar interbody fusion [ALIF] and lateral lumbar interbody fusion [LLIF] using directional real-time neural monitoring) to treat foraminal height loss, moderate to minor ASD, and mild central and lateral recess stenosis without instability or deformity ( Fig. 1 ). The decision to add posterior percutaneous instrumentation is made by the surgeon and is often considered in cases of mobile

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Michael D. White, Kristy Latour, Martina Giordano, Tavis Taylor, and Nitin Agarwal

specialty fields. 6–11 However, there is scarce literature addressing YouTube content on minimally invasive spine surgery. With spinal pain remaining the leading cause of global disability since 1990, 12 many advances in minimally invasive spine surgery have been developed to treat a variety of lumbar spine pathologies. Among these new minimally invasive treatment options, lateral lumbar interbody fusion (LLIF) offers a lateral approach to the lumbar disc space and has grown in popularity because it offers several advantages over posterior and anterior approaches, such

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Yamaan S. Saadeh, Clay M. Elswick, Eleanor Smith, Timothy J. Yee, Michael J. Strong, Kevin Swong, Brandon W. Smith, Mark E. Oppenlander, Osama N. Kashlan, and Paul Park

T he lateral lumbar interbody fusion (LLIF) technique was initially described in 2006. 1 Since then, its popularity and use have increased dramatically. In comparison with traditional posterior interbody fusion techniques, studies have demonstrated superiority in improved segmental lordosis and higher fusion rates. 2 Although the LLIF technique is generally considered safe, complications can occur. Well-described complications from the lateral approach include femoral nerve injuries resulting in transient or permanent weakness in hip flexion, pain or

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Lateral lumbar interbody fusion in the elderly: a 10-year experience

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Nitin Agarwal, Andrew Faramand, Nima Alan, Zachary J. Tempel, D. Kojo Hamilton, David O. Okonkwo, and Adam S. Kanter

, elderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications. Minimally invasive spine surgery was first presented as an alternative to open surgery in 1991. 22 Lateral lumbar interbody fusion (LLIF) is a surgical technique that entails gaining access to the lumbar spine through a lateral approach by passing through the retroperitoneal fat and the psoas major muscle. 23 The main advantages of this approach include decreased intraoperative blood loss, lower intraoperative narcotic

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Gautam Nayar, Souvik Roy, Waseem Lutfi, Nitin Agarwal, Nima Alan, Alp Ozpinar, D. Kojo Hamilton, David O. Okonkwo, and Adam S. Kanter

to the spine were developed with a goal of decreasing surgical morbidity. Lateral lumbar interbody fusion (LLIF) utilizing a transpsoas approach avoids disruption to the posterior ligaments and musculature. 5 The increased stability this inherently provides carries a theoretical benefit of lowering rates of operative ASD. In the current study, we report our institutional experience with ASD requiring reoperation after LLIF over an extended follow-up period of 4 years. Methods Patient Variables and Outcomes A retrospective review of 276 patients

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Yoshifumi Kudo, Ichiro Okano, Tomoaki Toyone, Akira Matsuoka, Hiroshi Maruyama, Ryo Yamamura, Koji Ishikawa, Chikara Hayakawa, Soji Tani, Masaya Sekimizu, Yushi Hoshino, Tomoyuki Ozawa, Toshiyuki Shirahata, Masayori Fujita, Yusuke Oshita, Haruka Emori, Hiroaki Omata, and Katsunori Inagaki

infection (SSI). 1–4 Lateral lumbar interbody fusion (LLIF) is a relatively new minimally invasive surgical technique used as an alternative to PLIF/TLIF. 5 , 6 One advantage of LLIF is its feasibility of achieving neural decompression indirectly by reducing disc bulging, elongating the ligamentum flavum by restoring disc height, and reducing spondylolisthesis with ligamentotaxis. 7–9 Currently, only a few reports have shown the clinical evaluation of LLIF for revision surgery. Moreover, these studies were performed on heterogeneous patient populations, including LLIF

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Jacob R. Joseph, Brandon W. Smith, Rakesh D. Patel, and Paul Park

T he lateral lumbar interbody fusion (LLIF) technique was initially described by Ozgur et al. in 2006. 11 LLIF has alternatively been described as extreme lateral interbody fusion or direct lateral interbody fusion. 6 , 11 This minimally invasive retroperitoneal transpsoas approach allows for a more robust discectomy than traditional posterior approaches, while causing minimal blood loss and decreased postoperative pain. 5 However, the operative approach does place the surgeon directly adjacent to the lumbosacral plexus. To avoid nerve injury

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David J. Moller, Nicholas P. Slimack, Frank L. Acosta Jr., Tyler R. Koski, Richard G. Fessler, and John C. Liu

and abstracts that describe morbidity of the minimally invasive lateral lumbar interbody fusion, but most do not specifically focus on transpsoas muscle morbidity. 11 , 21 In our experience, there are 3 primary symptoms associated with the transpsoas approach, including thigh and/or groin pain and numbness, as well as hip flexion weakness. These symptoms are most often temporary and resolve within 2 months. Initial findings were elicited on postoperative motor and sensory examinations while patients were still in the hospital, and they were not due to patients