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
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
Jotham C. Manwaring, Konrad Bach, Amir A. Ahmadian, Armen R. Deukmedjian, Donald A. Smith, and Juan S. Uribe
balance through an MI surgical technique is desired, the lateral MI-LIF with ACR is a feasible option. Another surgical option for sagittal balance correction is the “less invasive” OptiMesh TLIF (Spineology, Inc.) combined with posterior percutaneous instrumentation, as recently reported by Wang. 32 He shows lumbar lordosis correction of 17.8° and sagittal vertebral axis correction of 3.2 cm over long regional spine constructs. Although statistically significant, these results reveal the inferior segmental power of the TLIF to correct sagittal vertebral axis
Peter G. Campbell, Pierce D. Nunley, David Cavanaugh, Eubulus Kerr, Philip Andrew Utter, Kelly Frank, and Marcus Stone
Recently, 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.
The 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.
Fifteen 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.
This 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.
Surgeons 2015.3.FOC-DSPNABSTRACTS Mayfield Clinical Science Award 212. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: A Multi-center Analysis Doniel Drazin , MD MA , Terrence T. Kim , MD , Faris Shweikeh , BS , Luis Marchi , MSc , Jonathan N Sembrano , MD , Joseph R O'Brien , MD MPH , Luiz Pimenta , MD , and J. Patrick Johnson , MD Cedars-Sinai Medical Center; Instituto de Patologia da Coluna; University of MInnesota; George
Sapan D. Gandhi, David S. Liu, Evan D. Sheha, and Matthew W. Colman
decompression, the authors favor open posterior and staged lateral corpectomy approaches. Single-position/stage spinal surgery involving the lateral approach has been mostly described in the lateral position, only allowing for posterior percutaneous instrumentation. 13–15 The prone transpsoas approach is a newer technique that captures the benefits of direct decompression and lateral corpectomy into a single stage, which has incremental synergistic benefits based on simultaneous access. To our knowledge, this is the first published report of simultaneous lateral transpsoas
Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes
Presented at the 2013 Spine Section Meeting
Amir Ahmadian, Sean Verma, Gregory M. Mundis Jr., Rod J. Oskouian Jr., Donald A. Smith, and Juan S. Uribe
retractor ( Figs. 1 and 2 ). Great care was taken not to violate the L4–5 foramen. Directional EMG was used to ensure docking of the retractor was anterior to the femoral nerve. Subsequently, posterior percutaneous instrumentation was placed at corresponding levels. The restoration of disc height by the lateral cage provided partial reduction of listhesis (approximately 50%). The percutaneous posterior approach was performed with initial locking of the inferior pedicle screw (L-5) and thereby creating a cantilever to further reduce the remaining segmental listhesis
Antoine Jaeger, David Giber, Claire Bastard, Benjamin Thiebaut, François Roubineau, Charles Henri Flouzat Lachaniette, and Arnaud Dubory
.6%) who underwent surgery during the perimenopause. The lack of data are directly associated with the retrospective assessment of the cohort, which constitutes another drawback of the present study. Stand-alone L5–S1 ALIF is an appropriate surgical procedure to treat DDD. In patients with isthmic spondylolisthesis or Roussouly’s type 4 sagittal lumbar alignment with high PI, 30 this method should be used with caution. In the presence of spondylolisthesis or high PI and high SS, it is preferable to add posterior percutaneous instrumentation to the treatment objectives
Armen R. Deukmedjian, Amir Ahmadian, Konrad Bach, Alexandros Zouzias, and Juan S. Uribe
scoliosis using minimally invasive lateral anterior/posterior interbody arthrodesis, anterior column release, posterior decompression, and posterior percutaneous instrumentation. We also discuss the use of hybrid constructs incorporating traditional posterior osteotomies. Our objectives of this project are to: 1) present and validate a surgical method for utilization of the lateral MIS approach for adult degenerative scoliosis; 2) analyze construct-specific clinical outcomes and complications; and 3) determine the limitation of lateral MIS for adult degenerative scoliosis
Mohammed Ali Alvi, Redab Alkhataybeh, Waseem Wahood, Panagiotis Kerezoudis, Sandy Goncalves, M. Hassan Murad, and Mohamad Bydon
: Prevalence of disabilities and associated health conditions among adults—United States, 1999 . JAMA 285 : 1571 – 1572 , 2001 11302137 10 DerSimonian R , Laird N : Meta-analysis in clinical trials . Control Clin Trials 7 : 177 – 188 , 1986 3802833 10.1016/0197-2456(86)90046-2 11 Drazin D , Kim TT , Johnson JP : Simultaneous lateral interbody fusion and posterior percutaneous instrumentation: early experience and technical considerations . BioMed Res Int 2015 : 458284 , 2015 26649303 10.1155/2015/458284 12 Essig DA , Cho W , Hughes AP
Praveen V. Mummaneni, Ibrahim Hussain, Christopher I. Shaffrey, Robert K. Eastlack, Gregory M. Mundis Jr., Juan S. Uribe, Richard G. Fessler, Paul Park, Leslie Robinson, Joshua Rivera, Dean Chou, Adam S. Kanter, David O. Okonkwo, Pierce D. Nunley, Michael Y. Wang, Frank La Marca, Khoi D. Than, Kai-Ming Fu, and the International Spine Study Group
give the same amount of segmental correction as the hyperlordotic cage that the surgeon uses because, in a cMIS procedure, facetectomies are often not performed during posterior percutaneous instrumentation. A similar phenomenon occurs with LLIF and ACR. Leveque et al. demonstrated that segmental lordosis correction with ACR is on average 54% of the implanted cage lordosis. 32 A second interesting finding is that our MIS TLIF data are consistent with other published works and represent a reproducible average for what can be expected using this technique. 26 , 27