scholarly journals Lateral Transpsoas Fusion: Indications and Outcomes

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Vishal C. Patel ◽  
Daniel K. Park ◽  
Harry N. Herkowitz
Keyword(s):  
Interbody Fusion ◽  
Motor Deficits ◽  
Low Grade ◽  
Disc Disease ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lower Blood ◽  
Short And Long Term ◽  
Lateral Interbody

Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

Nerve injury during the transpsoas approach for lumbar fusion

2011 ◽  
Vol 15 (3) ◽  
pp. 280-284 ◽  
Author(s):  
John K. Houten ◽  
Lucien C. Alexandre ◽  
Rani Nasser ◽  
Adam L. Wollowick
Keyword(s):  
Nerve Injury ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Iliopsoas Muscle ◽  
Motor Deficits ◽  
Limited Information ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Clinical Events ◽  
Lateral Interbody

A lateral transpsoas approach to achieve interbody fusion in the lumbar spine using either the extreme lateral interbody fusion or direct lateral interbody fusion technique is an increasingly popular method to treat spinal disease. Dissection and dilation through the iliopsoas muscle places the lumbosacral plexus at risk for injury, but there is very limited information in the published literature about adverse clinical events resulting in postoperative motor deficits or reports of failure of electrophysiological monitoring to detect nerve injury. The authors present 2 cases of postoperative motor deficits following the transpsoas approach not detected by intraoperative monitoring, review the medical literature, and discuss strategies for complication avoidance.

scholarly journals A psoas splitting approach developed for outpatient lateral interbody fusion versus a standard transpsoas approach

2018 ◽  
Vol 4 (2) ◽  
pp. 195-202 ◽  
Author(s):  
Kingsley R. Chin ◽  
Fabio J. R. Pencle ◽  
Morgan D. Brown ◽  
Jason A. Seale
Keyword(s):  
Interbody Fusion ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lateral Interbody

scholarly journals Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Luis Marchi ◽  
Nitamar Abdala ◽  
Leonardo Oliveira ◽  
Rodrigo Amaral ◽  
Etevaldo Coutinho ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Lateral Approach ◽  
Low Grade ◽  
Mean Values ◽  
Single Level ◽  
Lateral Interbody Fusion ◽  
Cage Subsidence ◽  
Lateral Interbody

The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6±10 y/o; 73.1% female;27.4±3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.). The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P<0.001) and was maintained through 24 months (7.1%,P<0.001). Segmental lordosis (P<0.001) and disc height (P<0.001) were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17%) and 7/52 cases (13%) spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine

2009 ◽  
Vol 10 (2) ◽  
pp. 139-144 ◽  
Author(s):  
David M. Benglis ◽  
Steve Vanni ◽  
Allan D. Levi
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Psoas Muscle ◽  
Anatomical Study ◽  
Lumbosacral Plexus ◽  
Disc Space ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lateral Interbody

Object Minimally invasive anterolateral approaches to the lumbar spine are options for the treatment of a number of adult degenerative spinal disorders. Nerve injuries during these surgeries, although rare, can be devastating complications. With an increasing number of spine surgeons utilizing minimal access retroperitoneal surgery to treat lumbar problems, the frequency of complications associated with this approach will likely increase. The authors sought to better understand the location of the lumbar contribution of the lumbosacral plexus relative to the disc spaces encountered when performing the minimally invasive transpsoas approach, also known as extreme lateral interbody fusion or direct lateral interbody fusion. Methods Three fresh cadavers were placed lateral, and a total of 3 dissections of the lumbar contribution of the lumbosacral plexus were performed. Radiopaque soldering wire was then laid along the anterior margin of the nerve fibers and the exiting femoral nerve. Markers were placed at the disc spaces and lateral fluoroscopy was used to measure the location of the lumbar plexus along each respective disc space in the lumbar spine (L1–2, L2–3, L3–4, and L4–5). Results The lumbosacral plexus was found lying within the substance of the psoas muscle between the junction of the transverse process and vertebral body and exited along the medial edge of the psoas distally. The lumbosacral plexus was most dorsally positioned at the posterior endplate of L1–2. A general trend of progressive ventral migration of the plexus on the disc space was noted at L2–3, L3–4, and L4–5. Average ratios were calculated at each level (location of the plexus from the dorsal endplate to total disc length) and were 0 (L1–2), 0.11 (L2–3), 0.18 (L3–4), and 0.28 (L4–5). Conclusions This anatomical study suggests that positioning the dilator and/or retractor in a posterior position of the disc space may result in nerve injury to the lumbosacral plexus, especially at the L4–5 level. The risk of injuring inherent nerve branches directed to the psoas muscle as well as injury to the genitofemoral nerve do still exist.

scholarly journals Minimally invasive lateral transpsoas approach for lumbar corpectomy and stabilization

2019 ◽  
Vol 10 ◽  
pp. 153
Author(s):  
Umesh Srikantha ◽  
Yadhu Kasetti Lokanath ◽  
Akshay Hari ◽  
S. Nirmala ◽  
Ravi Gopal Varma
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Compression Fracture ◽  
Early Mobilization ◽  
Tubular Retractor ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lateral Interbody ◽  
Anterior Column Reconstruction ◽  
Lumbar Corpectomy

Background: Here, we present our experience with the minimally invasive (MI) transpsoas approach for lumbar corpectomy and stabilization. Transpsoas approach accesses the lumbar spine and includes both the direct lateral interbody fusion and extreme lateral interbody fusion techniques. Both procedures utilize a tubular retractor system which facilitates adequate retraction and direct visualization of the target, while supposedly reducing soft tissue trauma. Case Description: We evaluated two patients, one with a traumatic L2 wedge compression fracture and the other with an L3 pathological compression fracture due to multiple myeloma. Both patients underwent MI transpsoas lumbar corpectomy, anterior column reconstruction with an expandable cage, and posterior pedicle screw instrumentation to correct a kyphotic deformity. Both patients were mobilized on the 1st postoperative day and experienced significant postoperative pain relief. Conclusion: In two cases involving L2 and L3 compression fractures, MI transpsoas lumbar corpectomy was safely performed, with reduced perioperative and postoperative morbidity. Here, the transpsoas approach also allowed for early mobilization, adequate postoperative biomechanical stability, and resulted in immediate good outcomes.

Sign in / Sign up

Export Citation Format

Share Document