Complications for minimally invasive lateral interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches

Restricted access

OBJECTIVE

Minimally invasive anterolateral retroperitoneal approaches for lumbar interbody arthrodesis have distinct advantages attractive to spine surgeons. Prepsoas or transpsoas trajectories can be employed with differing complication profiles because of the inherent anatomical differences encountered in each approach. The evidence comparing them remains limited because of poor quality data. Here, the authors sought to systematically review the available literature and perform a meta-analysis comparing the two techniques.

METHODS

A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was used to identify eligible studies. Prepsoas and transpsoas studies were compiled, and each study was assessed for inclusion criteria. Complication rates were recorded and compared between approach groups. Studies incorporating an analysis of postoperative subsidence and pseudarthrosis rates were also assessed and compared.

RESULTS

For the prepsoas studies, 20 studies for the complications analysis and 8 studies for the pseudarthrosis outcomes analysis were included. For the transpsoas studies, 39 studies for the complications analysis and 19 studies for the pseudarthrosis outcomes analysis were included. For the complications analysis, 1874 patients treated via the prepsoas approach and 4607 treated with the transpsoas approach were included. In the transpsoas group, there was a higher rate of transient sensory symptoms (21.7% vs 8.7%, p = 0.002), transient hip flexor weakness (19.7% vs 5.7%, p < 0.001), and permanent neurological weakness (2.8% vs 1.0%, p = 0.005). A higher rate of sympathetic nerve injury was seen in the prepsoas group (5.4% vs 0.0%, p = 0.03). Of the nonneurological complications, major vascular injury was significantly higher in the prepsoas approach (1.8% vs 0.4%, p = 0.01). There was no difference in urological or peritoneal/bowel injury, postoperative ileus, or hematomas (all p > 0.05). A higher infection rate was noted for the transpsoas group (3.1% vs 1.1%, p = 0.01). With regard to postoperative fusion outcomes, similar rates of subsidence (12.2% prepsoas vs 13.8% transpsoas, p = 0.78) and pseudarthrosis (9.9% vs 7.5%, respectively, p = 0.57) were seen between the groups at the last follow-up.

CONCLUSIONS

Complication rates vary for the prepsoas and transpsoas approaches owing to the variable retroperitoneal anatomy encountered during surgical dissection. While the risks of a lasting motor deficit and transient sensory disturbances are higher for the transpsoas approach, there is a reciprocal reduction in the risks of major vascular injury and sympathetic nerve injury. These results can facilitate informed decision-making and tailored surgical planning regarding the choice of minimally invasive anterolateral access to the spine.

ABBREVIATIONS DLIF = direct lateral interbody fusion; LLIF = lateral lumbar interbody fusion; OLIF = oblique lateral interbody fusion; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; XLIF = extreme lateral interbody fusion.

Article Information

Correspondence Corey T. Walker: Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ. corey.walker@barrowbrainandspine.com.

INCLUDE WHEN CITING Published online January 25, 2019; DOI: 10.3171/2018.9.SPINE18800.

C.T.W. and S.H.F. contributed equally to this work.

Disclosures Dr. Uribe receives consulting fees and royalties from NuVasive Medical Inc. and is a consultant for Masonix Inc. and SI Bone Inc. Dr. Turner receives consulting fees from NuVasive Medical Inc. and SeaSpine Inc. Dr. Porter is the owner and founder of Medical Memory Inc. The other authors have no competing interests to disclose related to this study.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Anatomical illustration depicting the critical visceral, vascular, muscular, and neural structures at risk during the approach of minimally invasive retroperitoneal interbody arthrodesis procedures. Copyright Barrow Neurological Institute. Published with permission.

  • View in gallery

    Flowchart demonstrating systematic review of the literature, study selection, and inclusion for analysis for the prepsoas approach. Data added to the PRISMA template (from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097) under the terms of the Creative Commons Attribution License. Figure is available in color online only.

  • View in gallery

    Flowchart demonstrating systematic review of the literature, study selection, and inclusion for analysis for the transpsoas approach. Data added to the PRISMA template (from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097) under the terms of the Creative Commons Attribution License. Figure is available in color online only.

  • View in gallery

    Forest plot of complication rates for both the prepsoas and transpsoas approaches. Data are represented as the proportion of patients with that complication and the 95% confidence interval. Figure is available in color online only.

References

1

Abbasi HMiller LAbbasi AOrandi VKhaghany K: Minimally invasive scoliosis surgery with oblique lateral lumbar interbody fusion: single surgeon feasibility study. Cureus 9:e13892017

2

Abe KOrita SMannoji CMotegi HAramomi MIshikawa T: Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey. Spine (Phila Pa 1976) 42:55622017

3

Ahmadian ABach KBolinger BMalham GMOkonkwo DOKanter AS: Stand-alone minimally invasive lateral lumbar interbody fusion: multicenter clinical outcomes. J Clin Neurosci 22:7407462015

4

Ahmadian AVerma SMundis GM JrOskouian RJ JrSmith DAUribe JS: Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4-5 spondylolisthesis: clinical outcomes. J Neurosurg Spine 19:3143202013

5

Aichmair ALykissas MGGirardi FPSama AALebl DRTaher F: An institutional six-year trend analysis of the neurological outcome after lateral lumbar interbody fusion: a 6-year trend analysis of a single institution. Spine (Phila Pa 1976) 38:E1483E14902013

6

Alimi MHofstetter CPCong GTTsiouris AJJames ARPaulo D: Radiological and clinical outcomes following extreme lateral interbody fusion. J Neurosurg Spine 20:6236352014

7

Anand NBaron EM: Urological injury as a complication of the transpsoas approach for discectomy and interbody fusion. J Neurosurg Spine 18:18232013

8

Cahill KSMartinez JLWang MYVanni SLevi AD: Motor nerve injuries following the minimally invasive lateral transpsoas approach. J Neurosurg Spine 17:2272312012

9

Castro COliveira LAmaral RMarchi LPimenta L: Is the lateral transpsoas approach feasible for the treatment of adult degenerative scoliosis? Clin Orthop Relat Res 472:177617832014

10

Choudhri TFMummaneni PVDhall SSEck JCGroff MWGhogawala Z: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion status. J Neurosurg Spine 21:23302014

11

Chun DSBaker KCHsu WK: Lumbar pseudarthrosis: a review of current diagnosis and treatment. Neurosurg Focus 39(4):E102015

12

Dakwar ECardona RFSmith DAUribe JS: Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28(3):E82010

13

Dakwar ELe TVBaaj AALe AXSmith WDAkbarnia BA: Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 31(4):E182011

14

DiGiorgio AMEdwards CSVirk MSMummaneni PVChou D: Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series. Neurosurg Focus 43(2):E142017

15

Domínguez ILuque RNoriega MRey JAlia JMarco-Martínez F: Extreme lateral lumbar interbody fusion. Surgical technique, outcomes and complications after a minimum of one year follow-up. Rev Esp Cir Ortop Traumatol 61:8182017

16

Du JYKiely PDAl Maaieh MAichmair AHuang RC: Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report. J Spine Surg 3:3303372017

17

Formica MBerjano PCavagnaro LZanirato APiazzolla AFormica C: Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23 (Suppl 6):6846922014

18

Fujibayashi SHynes RAOtsuki BKimura HTakemoto MMatsuda S: Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 40:E175E1822015

19

Fujibayashi SOtsuki BKimura HTanida SMasamoto KMatsuda S: Preoperative assessment of the ureter with dual-phase contrast-enhanced computed tomography for lateral lumbar interbody fusion procedures. J Orthop Sci 22:4204242017

20

Gragnaniello CSeex K: Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment. J Spine Surg 2:2562652016

21

Grimm BDLeas DPPoletti SCJohnson DR II: Postoperative complications within the first year after extreme lateral interbody fusion: experience of the first 108 patients. Clin Spine Surg 29:E151E1562016

22

Heo DHKim JS: Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus 43(2):E132017

23

Hynes R: Oblique lateral interbody fusion (OLIF) technique and complications in 457 levels L1 to S1, presented at the 14th Annual Conference of the International Society for the Advancement of Spine SurgeryApril 30–May 2 2014 (http://www.isass.org/abstracts/isass14_oral_posters/isass14-77-Oblique-Lateral-Interbody-Fusion-(OLIF)-Technique-and-Complications-in.html) [Accessed October 9 2018]

24

Isaacs REHyde JGoodrich JARodgers WBPhillips FM: A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35 (26 Suppl):S322S3302010

25

Jin JRyu KSHur JWSeong JHKim JSCho HJ: Comparative study of the difference of perioperative complication and radiologic results: MIS-DLIF (minimally invasive direct lateral lumbar interbody fusion) versus MIS-OLIF (minimally invasive oblique lateral lumbar interbody fusion). Clin Spine Surg 31:31362018

26

Joseph JRSmith BWLa Marca FPark P: Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus 39(4):E42015

27

Kepler CKSharma AKHuang RC: Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report. J Spinal Disord Tech 24:3633672011

28

Khajavi KShen ALagina MHutchison A: Comparison of clinical outcomes following minimally invasive lateral interbody fusion stratified by preoperative diagnosis. Eur Spine J 24 (Suppl 3):3223302015

29

Khajavi KShen AY: Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J 23:121512232014

30

Kim JChoi WSung J: 314 minimally invasive oblique lateral interbody fusion for L4-5: clinical outcomes and perioperative complications. Neurosurgery 63 (Suppl 1):1901912016

31

Kim JSLee HSShin DAKim KNYoon DH: Correction of coronal imbalance in degenerative lumbar spine disease following direct lateral interbody fusion (DLIF). Korean J Spine 9:1761802012

32

Kim KTJo DJLee SHSeo EM: Oblique retroperitoneal approach for lumbar interbody fusion from L1 to S1 in adult spinal deformity. Neurosurg Rev 41:3553632018

33

Knight RQSchwaegler PHanscom DRoh J: Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech 22:34372009

34

Kotwal SKawaguchi SLebl DHughes AHuang RSama A: Minimally invasive lateral lumbar interbody fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech 28:1191252015

35

Kubota GOrita SUmimura TTakahashi KOhtori S: Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery: a case report. BMC Res Notes 10:1932017

36

Kueper JFantini GAWalker BRAichmair AHughes AP: Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique. Eur Spine J 24:8008092015

37

Le TVBaaj AADakwar EBurkett CJMurray GSmith DA: Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976) 37:126812732012

38

Le TVBurkett CJDeukmedjian ARUribe JS: Postoperative lumbar plexus injury after lumbar retroperitoneal transpsoas minimally invasive lateral interbody fusion. Spine (Phila Pa 1976) 38:E13E202013

39

Le TVSmith DAGreenberg MSDakwar EBaaj AAUribe JS: Complications of lateral plating in the minimally invasive lateral transpsoas approach. J Neurosurg Spine 16:3023072012

40

Lee HJKim JSRyu KSPark CK: Ureter injury as a complication of oblique lumbar interbody fusion. World Neurosurg 102:693.e7693.e142017

41

Lee YSKim YBPark SWChung C: Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion: clinical and radiological results. J Korean Neurosurg Soc 56:4694742014

42

Lee YSPark SWKim YB: Direct lateral lumbar interbody fusion: clinical and radiological outcomes. J Korean Neurosurg Soc 55:2482542014

43

Lykissas MGAichmair AHughes APSama AALebl DRTaher F: Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J 14:7497582014

44

Malham GMEllis NJParker RMSeex KA: Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions. Sci World J 2012:2469892012

45

Malham GMParker RMBlecher CMChow FYSeex KA: Choice of approach does not affect clinical and radiologic outcomes: a comparative cohort of patients having anterior lumbar interbody fusion and patients having lateral lumbar interbody fusion at 24 months. Global Spine J 6:4724812016

46

Marchi LAbdala NOliveira LAmaral RCoutinho EPimenta L: Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 19:1101182013

47

Mayer HM: A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine (Phila Pa 1976) 22:691699 7001997

48

Mehren CMayer HMZandanell CSiepe CJKorge A: The oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications. Clin Orthop Relat Res 474:202020272016

49

Miller JD: Timing of radiographic assessment of fusion. J Neurosurg Spine 22:2192015 (Letter)

50

Moher DLiberati ATetzlaff JAltman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e10000972009

51

Moller DJSlimack NPAcosta FL JrKoski TRFessler RGLiu JC: Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity. Neurosurg Focus 31(4):E42011

52

Na YCLee HSShin DAHa YKim KNYoon DH: Initial clinical outcomes of minimally invasive lateral lumbar interbody fusion in degenerative lumbar disease: a preliminary report on the experience of a single institution with 30 cases. Korean J Spine 9:1871922012

53

Ohtori SMannoji COrita SYamauchi KEguchi YOchiai N: Mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spinal kyphoscoliosis. Asian Spine J 9:5655722015

54

Ohtori SOrita SYamauchi KEguchi YOchiai NKishida S: Mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for lumbar spinal degeneration disease. Yonsei Med J 56:105110592015

55

Ozgur BMAgarwal VNail EPimenta L: Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions. SAS J 4:41462010

56

Patel NPBirch BDDement SEElbert GA: The mini-open anterolateral approach for degenerative thoracolumbar disease. Clin Neurol Neurosurg 112:8538572010

57

Phillips FMIsaacs RERodgers WBKhajavi KTohmeh AGDeviren V: Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine (Phila Pa 1976) 38:185318612013

58

Pumberger MHughes APHuang RRSama AACammisa FPGirardi FP: Neurologic deficit following lateral lumbar interbody fusion. Eur Spine J 21:119211992012

59

Rodgers WBCox CSGerber EJ: Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech 23:3933972010

60

Rodgers WBGerber EJPatterson J: Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26322011

61

Saraph VLerch CWalochnik NBach CMKrismer MWimmer C: Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion. Eur Spine J 13:4254312004

62

Sato JOhtori SOrita SYamauchi KEguchi YOchiai N: Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis. Eur Spine J 26:6716782017

63

Sharma AKKepler CKGirardi FPCammisa FPHuang RCSama AA: Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 24:2422502011

64

Sihvonen THerno APaljärvi LAiraksinen OPartanen JTapaninaho A: Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 18:5755811993

65

Silvestre CMac-Thiong JMHilmi RRoussouly P: Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J 6:89972012

66

Sofianos DABriseño MRAbrams JPatel AA: Complications of the lateral transpsoas approach for lumbar interbody arthrodesis: a case series and literature review. Clin Orthop Relat Res 470:162116322012

67

Tatsumi RLee YPKhajavi KTaylor WChen FBae H: In vitro comparison of endplate preparation between four mini-open interbody fusion approaches. Eur Spine J 24 (Suppl 3):3723772015

68

Tessitore EMolliqaj GSchaller KGautschi OP: Extreme lateral interbody fusion (XLIF): a single-center clinical and radiological follow-up study of 20 patients. J Clin Neurosci 36:76792017

69

Tohmeh AGKhorsand DWatson BZielinski X: Radiographical and clinical evaluation of extreme lateral interbody fusion: effects of cage size and instrumentation type with a minimum of 1-year follow-up. Spine (Phila Pa 1976) 39:E1582E15912014

70

Uribe JSArredondo NDakwar EVale FL: Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13:2602662010

71

Uribe JSDeukmedjian AR: Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J 24 (Suppl 3):3863962015

72

Uribe JSIsaacs REYoussef JAKhajavi KBalzer JRKanter AS: Can triggered electromyography monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a prospective multicenter trial. Eur Spine J 24 (Suppl 3):3783852015

73

Waddell BBriski DQadir RGodoy GHouston AHRudman E: Lateral lumbar interbody fusion for the correction of spondylolisthesis and adult degenerative scoliosis in high-risk patients: early radiographic results and complications. Ochsner J 14:23312014

74

Wang MYVasudevan RMindea SA: Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation. J Neurosurg Spine 21:8618662014

75

Woods KRBillys JBHynes RA: Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates. Spine J 17:5455532017

76

Xu DSWalker CTGodzik JTurner JDSmith WUribe JS: Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6:1042018

77

Zhang YHWhite IPotts EMobasser JPChou D: Comparison perioperative factors during minimally invasive pre-psoas lateral interbody fusion of the lumbar spine using either navigation or conventional fluoroscopy. Global Spine J 7:6576632017

78

Zoidl GGrifka JBoluki DWillburger REZoidl CKrämer J: Molecular evidence for local denervation of paraspinal muscles in failed-back surgery/postdiscotomy syndrome. Clin Neuropathol 22:71772003

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 302 302 140
Full Text Views 165 165 82
PDF Downloads 137 137 72
EPUB Downloads 0 0 0

PubMed

Google Scholar