Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions

Gregory M Malham, Ngaire J Ellis, Rhiannon M Parker, Kevin A Seex, Gregory M Malham, Ngaire J Ellis, Rhiannon M Parker, Kevin A Seex

Abstract

Introduction: The lateral transpsoas approach for lumbar interbody fusion (XLIF) is gaining popularity. Studies examining a surgeon's early experience are rare. We aim to report treatment, complication, clinical, and radiographic outcomes in an early series of patients.

Methods: Prospective data from the first thirty patients treated with XLIF by a single surgeon was reviewed. Outcome measures included pain, disability, and quality of life assessment. Radiographic assessment of fusion was performed by computed tomography.

Results: Average follow-up was 11.5 months, operative time was 60 minutes per level and blood loss was 50 mL. Complications were observed: clinical subsidence, cage breakage upon insertion, new postoperative motor deficit and bowel injury. Approach side-effects were radiographic subsidence and anterior thigh sensory changes. Two patients required reoperation; microforaminotomy and pedicle screw fixation respectively. VAS back and leg pain decreased 63% and 56%, respectively. ODI improved 41.2% with 51.3% and 8.1% improvements in PCS and MCS. Complete fusion (last follow-up) was observed in 85%.

Conclusion: The XLIF approach provides superior treatment, clinical outcomes and fusion rates compared to conventional surgical approaches with lowered complication rates. Mentor supervision for early cases and strict adherence to the surgical technique including neuromonitoring is essential.

Figures

Figure 1
Figure 1
Abdominal axial computed tomography (CT) showing intraperitoneal free air following unrecognized bowel perforation.
Figure 2
Figure 2
Change in minimum, maximum, and average low back pain (LBP) from preoperative to last followup (mean 11.5 months).
Figure 3
Figure 3
Change in minimum, maximum, and average leg pain (LP) from preoperative to last followup (mean 11.5 months).
Figure 4
Figure 4
Change in average disability (ODI), and physical and mental quality of life (PCS and MCS) from preoperative to last followup (mean 11.5 months).
Figure 5
Figure 5
Coronal computed tomography (CT) showing solid arthrodesis at 12 months postoperative following L4-5 XLIF.

References

    1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine Journal. 2006;6(4):435–443.
    1. Shamji MF, Isaacs RE. Anterior-only approaches to scoliosis. Neurosurgery. 2008;63(supplement 3):A139–A148.
    1. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. Journal of Spinal Disorders and Techniques. 2011;24(4):242–250.
    1. Rodgers WB, Gerber EJ, Patterson JR. Fusion after minimally disruptive anterior lumbar interbody fusion: analysis of extreme lateral interbody fusion by computed tomography. SAS Journal. 2010;4(2):63–66.
    1. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine. 1993;18(15):2227–2230.
    1. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB. Visceral and vascular complications resulting from anterior lumbar interbody fusion. Journal of Neurosurgery. 1999;91(supplement 1):60–64.
    1. Tiusanen H, Seitsalo S, Osterman K, Soini J. Retrograde ejaculation after anterior interbody lumbar fusion. European Spine Journal. 1995;4(6):339–342.
    1. Wood KB, Devine J, Fischer D, Dettori JR, Janssen M. Vascular injury in elective anterior lumbosacral surgery. Spine. 2010;35(supplement 9):S66–S75.
    1. Rihn JA, Patel R, Makda J, et al. Complications associated with single-level transforaminal lumbar interbody fusion. Spine Journal. 2009;9(8):623–629.
    1. Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ. Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. Journal of Spinal Disorders and Techniques. 2006;19(2):92–97.
    1. Hyde J, Seits M. Clinical experience, outcomes, and learning curve following XLIF for lumbar degenerative conditions. World Spinal Column Journal. 2011;2(1):21–26.
    1. Nowitzke AM. Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery. 2005;56(4):755–761.
    1. Williams AL, Gornet MF, Burkus JK. CT evaluation of lumbar interbody fusion: current concepts. American Journal of Neuroradiology. 2005;26(8):2057–2066.
    1. Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach: clinical article. Journal of Neurosurgery: Spine. 2011;14(1):31–37.
    1. Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine. 2010;35(supplement 26):S368–S374.
    1. Uribe JS, Smith WD, Pimenta L, et al. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience. Journal of Neurosurgery: Spine. 2012;16(3):264–279.
    1. Deviren V, Kuelling FA, Poulter G, Pekmezci M. Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. Journal of Spinal Disorders and Techniques. 2011;24(5):E40–E48.
    1. Marchi L, Oliveira L, Amaral R, et al. Lateral interbody fusion for treatment of discogenic low back pain: minimally invasive surgical techniques. Advanced Orthopaedics. 2012;2012282068
    1. Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurgical Focus. 2010;28(3):p. E8.
    1. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine. 2010;35(supplement 26):S322–S330.
    1. Marchi L, Abdala N, Oliveira L, et al. Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis. Scientific World Journal. 2012;2012456346
    1. Baaj AA, Dakwar E, Le TV, et al. Complications of the mini-open anterolateral approach to the thoracolumbar spine. Journal of Clinical Neuroscience. 2012;19(9):1265–1267.
    1. Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine. 2010;35(supplement 26):S338–S346.
    1. Uribe JS, Dakwar E, Cardona RF, Vale FL. Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases. Neurosurgery. 2011;68(supplement 1):32–39.
    1. Smith WD, Youssef JA, Christian G, Serrano S, Hyde JA. Lumbarized sacrum as a relative contraindication for lateral transpsoas interbody fusion at L5-6. Journal of Spinal Disorders & Techniques. 2011
    1. Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. Journal of Neurosurgery: Spine. 2006;4(4):304–309.
    1. Dakwar E, Vale FL, Uribe JS. Trajectory of the main sensory and motor branches of the lumbar plexus outside the psoas muscle related to the lateral retroperitoneal transpsoas approach. Laboratory investigation. Journal of Neurosurgery: Spine. 2011;14(2):290–295.
    1. Uribe JS, Arredondo N, Dakwar E, Vale FL. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. Journal of Neurosurgery: Spine. 2010;13(2):260–266.
    1. Davis TT, Bae HW, Mok MJ, et al. Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc. The Journal of Bone & Joint Surgery. 2011;93(16):1482–1487.
    1. Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY. An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion: clinical article. Journal of Neurosurgery: Spine. 2011;15(1):11–18.
    1. Le TV, Smith DA, Greenberg MS, et al. Complications of lateral plating in the minimally invasive lateral transpsoas approach. Journal of Neurosurgery: Spine. 2012;16(3):302–307.
    1. Mroz TE, Wang JC, Hashimoto R, Norvell DC. Complications related to osteobiologics use in spine surgery: a systematic review. Spine. 2010;35(supplement 9):S86–S104.
    1. Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurgical Focus. 2010;28(3):p. E7.
    1. Youssef JA, McAfee PC, Patty CA, et al. Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine. 2010;35(supplement 26):S302–S311.
    1. Blumenthal S, McAfee PC, Guyer RD, et al. A prospective, randomized, multicenter food and drug administration investigational device exemptions study of lumbar total disc replacement with the CHARITÉ™ artificial disc versus lumbar fusion—part I: evaluation of clinical outcomes. Spine. 2005;30(14):1565–1575.
    1. Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD. The Bagby and Kuslich method of lumbar interbody fusion: history, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine. 1998;23(11):1267–1279.
    1. Cappuccino A, Cornwall GB, Turner AWL, et al. Biomechanical analysis and review of lateral lumbar fusion constructs. Spine. 2010;35(supplement 26):S361–S367.
    1. Marchi L, Oliveira L, Amaral R, et al. Lateral interbody fusion for treatment of discogenic low back pain: minimally invasive surgical techniques. Advanced Orthopaedics. 2012;2012282068
    1. Marchi L, Abdala N, Oliveira L, et al. Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis. Scientific World Journal. 2012;2012456346
    1. Oliveira L, Marchi L, Coutinho E, Pimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine. 2010;35(supplement 26):S331–S337.
    1. Oliveira L, Marchi L, Coutinho E, et al. The use of rh-BMP2 in standalone Extreme Lateral Interbody Fusion (XLIF®): clinical and radiological results after 24 months follow-up. World Spinal Column Journal. 2010;1(1):19–25.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner