Minimally invasive extreme lateral lumbar interbody fusion (XLIF) to manage adjacent level disease – A case series and literature review

OBJECTIVE The rate of symptomatic adjacent-segment disease (ASD) after newer minimally invasive techniques, such as lateral lumbar interbody fusion (LLIF), is not known. This study aimed to assess the incidence of surgically significant ASD in adult patients who have undergone index LLIF and to identify any predictive factors. METHODS Patients who underwent index LLIF with or without additional posterior pedicle screw fixation between 2010 and 2012 and received a minimum of 2 years of postoperative follow-up were retrospectively included. Demographic and perioperative data were recorded, as well as radiographic data and immediate perioperative complications. The primary endpoint was revision surgery at the level above or below the previous construct, from which a survivorship model of patients with surgically significant symptomatic ASD was created. RESULTS Sixty-seven patients with a total of 163 interbody levels were included in this analysis. In total, 17 (25.4%) patients developed surgically significant ASD and required additional surgery, with a mean ± SD time to revision of 3.59 ± 2.55 years. The mean annual rate of surgically significant ASD was 3.49% over 7.27 years, which was the average follow-up. One-third of patients developed significant disease within 2 years of index surgery, and 1 patient required surgery at the adjacent level within 1 year. Constructs spanning 3 or fewer interbody levels were significantly associated with increased risk of surgically significant ASD; however, instrument termination at the thoracolumbar junction did not increase this risk. Surgically significant ASD was not impacted by preoperative disc height, foraminal area at the adjacent levels, or changes in global or segmental lumbar lordosis. CONCLUSIONS The risk of surgically significant ASD after LLIF was similar to the previously reported rates of other minimally invasive spine procedures. Patients with shorter constructs had higher rates of subsequent ASD.

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Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/2013.5.focus13157 ◽

2013 ◽

Vol 35 (2) ◽

pp. E7 ◽

Cited By ~ 37

Author(s):

Pedro S. Silva ◽

Paulo Pereira ◽

Pedro Monteiro ◽

Pedro A. Silva ◽

Rui Vaz

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Interbody Fusion ◽

Operative Time ◽

Pedicle Screws ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Adjacent Level ◽

Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

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Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2020.10.spine201239 ◽

2021 ◽

pp. 1-7

Author(s):

Austin Q. Nguyen ◽

Jackson P. Harvey ◽

Krishn Khanna ◽

Bryce A. Basques ◽

Garrett K. Harada ◽

...

Keyword(s):

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Preoperative Imaging ◽

Lumbar Interbody Fusion ◽

Adjacent Level ◽

Posterior Decompression ◽

Less Invasive ◽

Lateral Lumbar Interbody Fusion ◽

Reoperation Rates

OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. METHODS This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation. RESULTS The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995). CONCLUSIONS There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

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Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity

European Spine Journal ◽

10.1007/s00586-020-06352-4 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1362-1370 ◽

Cited By ~ 1

Author(s):

Tetsuro Ohba ◽

Shigeto Ebata ◽

Shota Ikegami ◽

Hiroki Oba ◽

Hirotaka Haro

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Improving accuracy and reducing radiation exposure in minimally invasive lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2009.11.spine09270 ◽

2010 ◽

Vol 12 (5) ◽

pp. 533-539 ◽

Cited By ~ 33

Author(s):

Martin James Wood ◽

Richard John Mannion

Keyword(s):

Minimally Invasive ◽

Radiation Exposure ◽

Interbody Fusion ◽

Case Series ◽

Guidance System ◽

Screw Placement ◽

Invasive Technique ◽

Computer Assisted ◽

Lumbar Interbody Fusion ◽

Screw Misplacement

Object The authors assessed the accuracy of placement of lumbar transpedicular screws by using a computer-assisted, imaged-guided, minimally invasive technique with continuous electromyography (EMG) monitoring. Methods This was a consecutive case series with prospective assessment of procedural accuracy. Forty-seven consecutive patients underwent minimally invasive lumbar interbody fusion and placement of pedicle screws (PSs). A computer-assisted image guidance system involving CT-based images was used to guide screw placement, while EMG continuously monitored the lumbar nerve roots at the operated levels with a 5-mA stimulus applied through the pedicle access needle. All patients underwent CT scanning to determine accuracy of PS placement. All episodes of adjusted screw trajectory based on positive EMG responses were recorded. Pedicle screw misplacement was defined as breach of the pedicle cortex by the screw of more than 2 mm. Results Two hundred twelve PSs were inserted in 47 patients. The screw misplacement rate was 4.7%. One patient experienced new postoperative radiculopathy resulting from a sacral screw that was too long, with lumbosacral trunk impingement. The trajectory of the pedicle access needle was altered intraoperatively on 20 occasions (9.4% of the PSs) based on positive EMG responses, suggesting that nerve root impingement may have resulted from these screws had the EMG monitoring not been used. Conclusions The combination of computer-assisted navigation combined with continuous EMG monitoring during pedicle cannulation results in a low rate of PS misplacement, with avoidance of screw positions that might cause neural injury. Furthermore, this technique allows reduction of the radiation exposure for the surgical team without compromising the accuracy of screw placement.

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