Changes in the Operative Corridor in Oblique Lumbar Interbody Fusion Between Preoperative Imaging and Intraoperative Cone-Beam Computed Tomography Using Morphometric Analysis

Abstract INTRODUCTION Oblique lumbar interbody fusion (OLIF) is a minimally-invasive technique that relies on a sufficient corridor anterior to the psoas and posterior to vascular structures.This intraoperative corridor is evaluated on preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging to guide patient selection.Previous cadaveric studies and preoperative MR imaging analysis have examined this corridor to determine corridor variations along right- and left-sided approaches and among patient characteristics.This is the first study that directly evaluates the true intraoperative corridor in the lateral decubitus position based on intraoperative 3D imaging. METHODS We performed a retrospective evaluation identifying patients > 18 yr old who had undergone an OLIF via a left-sided approach at 2 tertiary care centers from 2016 to 2018. Patients with scoliosis greater than 20 degrees, transitional anatomy, and psoas abnormalities were excluded.We recorded demographics and the intraoperative corridor defined by the distance between the left lateral border of the aorta or iliac vessels and anteromedial border of the psoas from L1-L2 through L4-5 disc spaces.This corridor was measured on supine, preoperative MR axial imaging and subsequent intraoperative 3D cone beam CT acquired in the right lateral decubitus position. RESULTS A total of 33 patients, 15 of whom were female, were included in this study.The average age was 65.4 and body mass index (BMI) was 31 kg/m2.There was a statistically significant increase (P < .05) in the intraoperative corridor from supine to lateral decubitus positioning at all levels.The greatest increase in corridor size was noted at L1-2 (3.1 cm) and least at L4-5 (2.1 cm).There was no statistically significant difference between age, BMI, or gender in the preoperative versus intraoperative corridor. CONCLUSION This is the first study to provide objective evidence to support that lateral decubitus positioning increases the intraoperative corridor for anterior to the psoas techniques.This information should increase confidence with an anterior to the psoas approach if there is adequate corridor size on supine preoperative imaging evaluation.

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Changes in the Operative Corridor in Oblique Lumbar Interbody Fusion Between Preoperative Magnetic Resonance Imaging and Intraoperative Cone-Beam Computed Tomography Using Morphometric Analysis

Cureus ◽

10.7759/cureus.8687 ◽

2020 ◽

Author(s):

Aqib Zehri ◽

Hector Soriano-Baron ◽

Keyan A Peterson ◽

Carol Kittel ◽

Patrick A Brown ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Morphometric Analysis ◽

Interbody Fusion ◽

Cone Beam ◽

Lumbar Interbody Fusion ◽

Resonance Imaging ◽

Oblique Lumbar Interbody Fusion ◽

Preoperative Magnetic Resonance

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Analysis of Intraoperative Cone-Beam Computed Tomography Combined With Image Guidance for Lateral Lumbar Interbody Fusion

Operative Neurosurgery ◽

10.1093/ons/opx176 ◽

2017 ◽

Vol 14 (6) ◽

pp. 620-626

Author(s):

Xilin Liu ◽

Jacob R Joseph ◽

Brandon W Smith ◽

Yamaan Saadeh ◽

Paul Park

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Cone Beam Computed Tomography ◽

Interbody Fusion ◽

Cone Beam ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Spinal Navigation ◽

Male Patients ◽

Biplanar Fluoroscopy

Abstract BACKGROUND Minimally invasive lateral lumbar interbody fusion (LLIF) is traditionally performed with biplanar fluoroscopy. Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in LLIF. OBJECTIVE To evaluate the accuracy and safety of cage placement using spinal navigation in LLIF, as well as to evaluate the radiation exposure to surgeon and staff during the procedure. METHODS The authors performed a retrospective analysis of a prospectively acquired database of patients undergoing LLIF with image-based navigation performed from April 2014 to July 2016 at a single institution. The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded. All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short-term complications associated with their LLIF. RESULTS Sixty-three patients comprising 117 spinal levels were included in the study. There were 36 (57.1%) female and 27 (42.9%) male patients. Mean age was 62.7 yr (range 24-79 yr). A mean 1.9 (range 1-4) levels per patient were treated. Cages were placed in the anterior or middle of 115 (98.3%) disc spaces. Image-guided cage trajectory was accurate in 116/117 levels (99.1%). In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level. Sixteen (25.4%) patients experienced a complication related to approach. CONCLUSION Use of intraoperative cone-beam computed tomography combined with spinal navigation for LLIF results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.

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Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Global Spine Journal ◽

10.1177/21925682211049170 ◽

2021 ◽

pp. 219256822110491

Author(s):

Ram Alluri ◽

Nicholas Clark ◽

Evan Sheha ◽

Karim Shafi ◽

Matthew Geiselmann ◽

...

Keyword(s):

Prone Position ◽

Interbody Fusion ◽

Femoral Nerve ◽

Psoas Muscle ◽

Lateral Decubitus Position ◽

Lumbar Plexus ◽

Lumbar Interbody Fusion ◽

Posterior Edge ◽

Disc Space ◽

Lateral Decubitus

Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

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Three-Dimensional Computed Tomography-Based Spinal Navigation in Minimally Invasive Lateral Lumbar Interbody Fusion: Feasibility, Technique, and Initial Results

Operative Neurosurgery ◽

10.1227/neu.0000000000000726 ◽

2015 ◽

Vol 11 (2) ◽

pp. 259-267 ◽

Cited By ~ 6

Author(s):

Paul Park

Keyword(s):

Computed Tomography ◽

Minimally Invasive ◽

Navigation System ◽

Interbody Fusion ◽

Cone Beam Ct ◽

Cone Beam ◽

Lumbar Interbody Fusion ◽

Disk Space ◽

Image Guided ◽

Spinal Navigation

Abstract BACKGROUND As with most minimally invasive spine procedures, lateral lumbar interbody fusion (LLIF) requires the use of biplanar fluoroscopy for localization and safe interbody cage placement. Computed tomography (CT)-based intraoperative spinal navigation has been shown to be more effective than fluoroscopic guidance for posterior-based approaches such as pedicle screw instrumentation. However, the use of spinal navigation in LLIF has not been well studied. OBJECTIVE To present the technique for using an intraoperative cone-beam CT and image-guided navigation system in LLIF and to provide a preliminary analysis of outcomes. METHODS We retrospectively analyzed a prospectively acquired database and the electronic records of patients undergoing LLIF with spinal navigation. Eight patients were identified. Postoperative neurological deficits were recorded. All patients underwent postprocedural CT and x-ray imaging for analysis of accuracy of cage placement. Accuracy of cage placement was determined by location within the disk space. RESULTS The mean age was 66 years, and 6 patients were women. A mean 2.8 levels were treated with a total of 22 lateral cages implanted via navigation. All cages were placed within quarters 1 to 2 or 2 to 3, signifying the anterior half or middle portions of the disk space. There were no sensory or motor deficits postoperatively. CONCLUSION Use of an intraoperative cone-beam CT with an image-guided navigation system is feasible and safe and appears to be accurate, although a larger study is required to confirm these results.

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Simultaneous Robotic Single Position Oblique Lumbar Interbody Fusion With Bilateral Sacropelvic Fixation in Lateral Decubitus

Neurospine ◽

10.14245/ns.2040774.387 ◽

2021 ◽

Vol 18 (2) ◽

pp. 406-412

Author(s):

Martin H. Pham ◽

Luis Daniel Diaz-Aguilar ◽

Vrajesh Shah ◽

Michael Brandel ◽

Joshua Loya ◽

...

Keyword(s):

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Sacropelvic Fixation ◽

Oblique Lumbar Interbody Fusion ◽

Lateral Decubitus

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Rate of failure of indirect decompression in lateral single-position surgery: clinical results

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20375 ◽

2020 ◽

Vol 49 (3) ◽

pp. E5

Author(s):

J. Alex Thomas ◽

Christopher I. M. Thomason ◽

Brett A. Braly ◽

Cristiano M. Menezes

Keyword(s):

Interbody Fusion ◽

Lateral Decubitus Position ◽

Foraminal Stenosis ◽

Lumbar Interbody Fusion ◽

Number Of Patients ◽

Indirect Decompression ◽

Surgical Data ◽

Lateral Decubitus ◽

The Mean ◽

Rate Of Failure

OBJECTIVELateral single-position surgery (LSPS) of the lumbar spine generally involves anterior lumbar interbody fusion (ALIF) performed in the lateral position (LALIF) at L5–S1 with or without lateral lumbar interbody fusion (LLIF) at L4–5 and above, followed by bilateral pedicle screw fixation (PSF) without repositioning the patient. One obstacle to more widespread adoption of LSPS is the perceived need for direct decompression of the neural elements, which typically requires flipping the patient to the prone position. The purpose of this study was to examine the rate of failure of indirect decompression in a cohort of patients undergoing LSPS from L4 to S1.METHODSA multicenter, post hoc analysis was undertaken from prospectively collected data of patients at 3 institutions who underwent LALIF at L5–S1 with or without LLIF at L4–5 with bilateral PSF in the lateral decubitus position between March 2018 and March 2020. Inclusion criteria were symptoms of radiculopathy or neurogenic claudication, central or foraminal stenosis (regardless of degree or etiology), and indication for interbody fusion at L5–S1 or L4–S1. Patients with back pain only; those who were younger than 18 years; those with tumor, trauma, or suspicion of infection; those needing revision surgery; and patients who required greater than 2 levels of fusion were excluded. Baseline patient demographic information and surgical data were collected and analyzed. The number of patients in whom indirect decompression failed was recorded and each individual case of failure was analyzed.RESULTSA total of 178 consecutive patients underwent LSPS during the time period (105 patients underwent LALIF at L5–S1 and 73 patients underwent LALIF at L5–S1 with LLIF at L4–5). The mean follow-up duration was 10.9 ± 6.5 months. Bilateral PSF was placed with the patient in the lateral decubitus position in 149 patients, and there were 29 stand-alone cases. The mean case time was 101.9 ± 41.5 minutes: 79.3 minutes for single-level cases and 134.5 minutes for 2-level cases. Three patients (1.7%) required reoperation for failure of indirect decompression.CONCLUSIONSThe rate of failure of indirect decompression in LSPS from L4 to S1 is exceedingly low. This low risk of failure should be weighed against the risks associated with direct decompression as well as the risks of the extra operative time needed to perform this decompression.

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Oblique Lumbar Interbody Fusion With Stereotactic Navigation: Technical Note

Global Spine Journal ◽

10.1177/2192568220910181 ◽

2020 ◽

Vol 10 (2_suppl) ◽

pp. 94S-100S

Author(s):

Winward Choy ◽

Rory Richard Mayer ◽

Praveen V. Mummaneni ◽

Dean Chou

Keyword(s):

Interbody Fusion ◽

Preoperative Evaluation ◽

Vena Cava ◽

Technical Note ◽

Invasive Technique ◽

Lumbar Interbody Fusion ◽

Evaluation Approach ◽

Surgical Technical ◽

Oblique Lumbar Interbody Fusion ◽

Technical Considerations

Study Design: Surgical technical note. Objectives: Describe the preoperative evaluation, approach, and technical considerations for an oblique lumbar interbody fusion using neuronavigation. Methods: A thorough review of previous technical and anatomic descriptions for pre- and transpsoas interbody techniques was performed and incorporated into the technical considerations warranting discussion for a navigated oblique lateral interbody fusion. Results: The prepsoas technique, also known as an oblique lumbar interbody fusion (OLIF), is an alternative approach for lumbar interbody fusion that utilizes a retroperitoneal corridor between the aorta/inferior vena cava. This corridor is devoid of neurovascular structures and obviates the need for real time electromyography monitoring. This approach spares the psoas and provides direct visualization of key structures and minimizes risk of injury to the great vessels, ureter, and lumbar plexus. Conclusions: A navigated prepsoas retroperitoneal approach is an effective minimally invasive technique for lumbar interbody fusion that may help mitigate some of the vascular and neurologic complications present with anterior lumbar interbody fusion or lateral lumbar interbody fusion and minimize radiation exposure to the surgeon.

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