Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

2010 ◽  
Vol 28 (3) ◽  
pp. E7 ◽  
Author(s):  
Matthew J. Tormenti ◽  
Matthew B. Maserati ◽  
Christopher M. Bonfield ◽  
David O. Okonkwo ◽  
Adam S. Kanter
Keyword(s):  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Combined Approach ◽  
Radiographic Outcomes ◽  
Scoliosis Correction ◽  
Extreme Lateral Interbody Fusion ◽  
The Mean ◽  
Lateral Interbody

Object The authors recently used a combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. Methods The authors retrospectively reviewed all deformity cases that were surgically corrected at the University of Pittsburgh Medical Center Presbyterian Hospital between June 2007 and August 2009. Eight patients underwent combined transpsoas and posterior approaches for adult degenerative thoracolumbar scoliosis. The comparison group consisted of 4 adult patients who underwent a posterior-only scoliosis correction. Data on intra- and postoperative complications were collected. The pre- and postoperative posterior-anterior and lateral scoliosis series radiographic films were reviewed, and comparisons were made for coronal deformity, apical vertebral translation (AVT), and lumbar lordosis. Clinical outcomes were evaluated by comparing pre- and postoperative visual analog scale scores. Results The median preoperative coronal Cobb angle in the combined approach was 38.5° (range 18–80°). Following surgery, the median Cobb angle was 10° (p < 0.0001). The mean preoperative AVT was 3.6 cm, improving to 1.8 cm postoperatively (p = 0.031). The mean preoperative lumbar lordosis in this group was 47.3°, and the mean postoperative lordosis was 40.4°. Compared with posterior-only deformity corrections, the mean values for curve correction were higher for the combined approach than for the posterior-only approach. Conversely, the mean AVT correction was higher in the posterior-only group. One patient in the posterior-only group required revision of the instrumentation. One patient who underwent the transpsoas XLIF approach suffered an intraoperative bowel injury necessitating laparotomy and segmental bowel resection; this patient later underwent an uneventful posterior-only correction of her scoliotic deformity. Two patients (25%) in the XLIF group sustained motor radiculopathies, and 6 of 8 patients (75%) experienced postoperative thigh paresthesias or dysesthesias. Motor radiculopathy resolved in 1 patient, but persisted 3 months postsurgery in the other. Sensory symptoms persisted in 5 of 6 patients at the most recent follow-up evaluation. The mean clinical follow-up time was 10.5 months for the XLIF group and 11.5 months for the posterior-only group. The mean visual analog scale score decreased from 8.8 to 3.5 in the XLIF group, and it decreased from 9.5 to 4 in the posterior-only group. Conclusions Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent.

scholarly journals The clinical and radiographic outcomes of stand-alone Oblique Lateral Interbody Fusion in Treatment of Adult Degenerative Scoliosis

2019 ◽  
Author(s):  
Chen Liu ◽  
Xin Ge ◽  
Yu Zhang ◽  
Liang Xiao ◽  
Hongguang Xu
Keyword(s):  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background The minimally invasive treatment for adult degenerative scoliosis has become more and more popular. The purpose of this study was to evaluate the efficiency of stand-alone oblique lateral interbody fusion for the treatment of adult degenerative scoliosis in terms of clinical and radiological outcomes. Methods A total of 18 patients with ADS who underwent stand-alone OLIF in our hospital from July 2017 to May 2018 were enrolled in the study. Clinical evaluations were performed with visual analogue scale (VAS) and Oswestry Disability Index (ODI). Radiographic outcomes were recorded in terms of coronal Cobb angle and lumbar lordosis. Results Mean patient age was 62.4 years, 50% of patients were female. Average follow up was 18.4 months. The average operative duration was 87.4 minutes, whilst the mean estimated blood loss was 45.6 ml. Mean coronal Cobb angle corrected from preoperative 15.2° to the final follow-up 6.8° (p < 0.05); and mean lumbar lordosis improved from preoperative 30.0° to 39.4° (p < 0.05). Mean disc height increased from preoperative 0.7 cm to 1.1 cm at final follow-up (p < 0.05). Mean VAS improved from 5.5 to 2.2 (p < 0.05). The mean preoperative and the final follow-up Oswestry Disability Indices were 27.8% and 13.1% respectively (p < 0.05). Conclusions Stand-alone OLIF could be regarded as an efficient and safe option in the treatment of ADS for careful selected patients.

Radiological and clinical outcomes following extreme lateral interbody fusion

2014 ◽  
Vol 20 (6) ◽  
pp. 623-635 ◽  
Author(s):  
Marjan Alimi ◽  
Christoph P. Hofstetter ◽  
Guang-Ting Cong ◽  
Apostolos John Tsiouris ◽  
Andrew R. James ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Large Population ◽  
Thoracolumbar Spine ◽  
Radiological Outcome ◽  
Lateral Interbody Fusion ◽  
Extreme Lateral Interbody Fusion ◽  
Lateral Interbody

Object Extreme lateral interbody fusion (ELIF) is a popular technique for anterior fixation of the thoracolumbar spine. Clinical and radiological outcome studies are required to assess safety and efficacy. The aim of this study was to describe the functional and radiological impact of ELIF in a degenerative disc disease population with a longer follow-up and to assess the durability of this procedure. Methods Demographic and perioperative data for all patients who had undergone ELIF for degenerative lumbar disorders between 2007 and 2011 were collected. Trauma and tumor cases were excluded. For radiological outcome, the preoperative, immediate postoperative, and latest follow-up coronal Cobb angle, lumbar sagittal lordosis, bilateral foraminal heights, and disc heights were measured. Pelvic incidence (PI) and PI–lumbar lordosis (PI-LL) mismatch were assessed in scoliotic patients. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as the Macnab criteria. Results One hundred forty-five vertebral levels were surgically treated in 90 patients. Pedicle screw and rod constructs and lateral plates were used to stabilize fixation in 77% and 13% of cases, respectively. Ten percent of cases involved stand-alone cages. At an average radiological follow-up of 12.6 months, the coronal Cobb angle was 10.6° compared with 23.8° preoperatively (p < 0.0001). Lumbar sagittal lordosis increased by 5.3° postoperatively (p < 0.0001) and by 2.9° at the latest follow-up (p = 0.014). Foraminal height and disc height increased by 4 mm (p < 0.0001) and 3.3 mm (p < 0.0001), respectively, immediately after surgery and remained significantly improved at the last follow-up. Separate evaluation of scoliotic patients showed no statistically significant improvement in PI and PI-LL mismatch either immediately postoperatively or at the latest follow-up. Clinical evaluation at an average follow-up of 17.6 months revealed an improvement in the ODI and the VAS scores for back, buttock, and leg pain by 21.1% and 3.7, 3.6, and 3.7 points, respectively (p < 0.0001). According to the Macnab criteria, 84.8% of patients had an excellent, good, or fair functional outcome. New postoperative thigh numbness and weakness was detected in 4.4% and 2.2% of the patients, respectively, which resolved within the first 3 months after surgery in all but 1 case. Conclusions This study provides what is to the authors' knowledge the most comprehensive set of radiological and clinical outcomes of ELIF in a fairly large population at a midterm follow-up. Extreme lateral interbody fusion showed good clinical outcomes with a low complication rate. The procedure allows for at least midterm clinically effective restoration of disc and foraminal heights. Improvement in coronal deformity and a small but significant increase in sagittal lordosis were observed. Nonetheless, no significant improvement in the PI-LL mismatch was achieved in scoliotic patients.

scholarly journals Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822097914
Author(s):  
Lei Zhu ◽  
Jun-Wu Wang ◽  
Liang Zhang ◽  
Xin-Min Feng
Keyword(s):  
Systematic Review ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Meta Analysis ◽  
Fusion Rate ◽  
The Mean ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Study Design: A systematic review and meta-analysis. Objectives: To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). Methods: We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. Results: A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. Conclusions: OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.

Complications in Extreme Lateral Interbody Fusion (XLIF®): A Retrospective Study in Siriraj Hospital

2021 ◽  
Vol 104 (6) ◽  
pp. 1027-1032
Keyword(s):  
Postoperative Complications ◽  
Surgical Complications ◽  
Interbody Fusion ◽  
Early Postoperative Complications ◽  
Lateral Interbody Fusion ◽  
Siriraj Hospital ◽  
Extreme Lateral Interbody Fusion ◽  
Lateral Interbody ◽  
Level Fusion

Background: Extreme Lateral Interbody Fusion (XLIF®) is a well-known transpsoas approach technique that confers advantages including excellent visualization, easy access to the lumbar disc, accommodation for a large anterior graft, restoration of disk height and lumbar alignment, and indirect decompression. However, no study in Thailand has investigated early postoperative complications after spinal fusion with XLIF surgery. Objective: To determine the early postoperative complication rates among Thai patients that underwent spinal fusion with XLIF procedure. Materials and Methods: The present study was a retrospective chart review to evaluate perioperative and early postoperative complications in patients that underwent spinal interbody fusion with XLIF procedure and were followed-up for a minimum of three months at the Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand between 2015 and 2019. Results: One hundred eighteen patients, including 82 females and 36 males, with a mean age of 64.2 years and 165 levels, that were operated upon, were included. Eighty patients (67.8%) underwent one-level fusion, 29 (24.6%) had two-level fusion, and 9 (7.6%) underwent three-level fusion. Immediate postoperative complications occurred in 66 patients (55.9%), consisting of eight (6.7%) with medical complications, 57 (48.3%) with surgical complications, and one (0.8%) with combined medical and surgical complications. Postoperative complications were resolved within three months after surgery in 48 patients. Forty-one patients (34.7%) had postoperative proximal lower limb neuropathy. Only 10 patients (24.4%) still had neuropathy at the 3-month follow-up, but it did not affect their function. Conclusion: Postoperative proximal limb neuropathy, including thigh numbness, pain, or hip flexor weakness, had a high prevalence in the present study despite intraoperative neurophysiologic monitoring; however, most cases resolved by the 3-month follow-up. Patient education about potential nerve irritation complication is recommended, and meticulous preoperative radiographic assessment and careful step-by-step intraoperative surgical approach may reduce the rates of these postoperative complications. Keywords: Extreme lateral interbody fusion; Complications; Neuropathy; Postoperative

scholarly journals Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

2014 ◽  
Vol 36 (5) ◽  
pp. E14 ◽  
Author(s):  
Neel Anand ◽  
Eli M. Baron ◽  
Babak Khandehroo
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Sagittal Plane ◽  
Adult Scoliosis ◽  
Angle Correction ◽  
Scoliosis Correction ◽  
Spinopelvic Parameter ◽  
Ceiling Effects ◽  
The Mean

Object Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results The mean preoperative SVA value was 60 mm (range 11.5–151 mm); the mean postoperative value was 31 mm (range 0–84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°–74.7°) and a mean postoperative value of 13.9° (range 0°–32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Conclusions Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.

Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study

2011 ◽  
Vol 15 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Frank L. Acosta ◽  
John Liu ◽  
Nicholas Slimack ◽  
David Moller ◽  
Richard Fessler ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Interbody Fusion ◽  
Sagittal Plane ◽  
Sagittal Alignment ◽  
Degenerative Scoliosis ◽  
Lateral Interbody Fusion ◽  
Global Sagittal Alignment ◽  
Degenerative Lumbar Disease ◽  
The Mean ◽  
Lateral Interbody

Object The lateral transpsoas approach for lumbar interbody fusion is a minimal access technique that has been used by some to treat lumbar degenerative conditions, including degenerative scoliosis. Few studies, however, have analyzed its effect on coronal and sagittal plane correction, and no study has compared changes in segmental, regional, and global coronal and sagittal alignment after this technique. The object of this study was to determine changes in sagittal and coronal plane alignment occurring after direct lateral interbody fusion (DLIF). Methods The authors performed a review of the radiographic records of 36 patients with lumbar degenerative disease treated with the DLIF technique. Thirty-five patients underwent supplemental posterior fixation to maintain correction. Preoperative and postoperative standing anteroposterior and lateral lumbar radiographs were obtained in all patients for measurement of segmental and regional coronal and sagittal Cobb angles. Standing anteroposterior and lateral 36-in radiographs were also obtained in 23 patients for measurement of global coronal (center sacral vertebral line) and sagittal (C-7 plumb line) balance. Results The mean coronal segmental Cobb angle was 4.5° preoperatively, and it was 1.5° postoperatively (p < 0.0001). The mean pre- and postoperative regional lumbar coronal Cobb angles were 7.6° and 3.6°, respectively (p = 0.0001). In 8 patients with degenerative scoliosis, the mean pre- and postoperative regional lumbar coronal Cobb angles were 21.4° and 9.7°, respectively (p = 0.0004). The mean global coronal alignment was 19.1 mm preoperatively, and it was 12.5 mm postoperatively (p < 0.05). In the sagittal plane, the mean segmental Cobb angle measured −5.3° preoperatively and −8.2° postoperatively (p < 0.0001). The mean pre- and postoperative regional lumbar lordoses were 42.1° and 46.2°, respectively (p > 0.05). The mean global sagittal alignment was 41.5 mm preoperatively and 42.4 mm postoperatively (p = 0.7). The average clinical follow-up was 21 months in 21 patients. The mean pre- and postoperative visual analog scale scores were 7.7 and 2.9, respectively (p < 0.0001). The mean pre- and postoperative Oswestry Disability Indices were 43 and 21, respectively (p < 0.0001). Conclusions Direct lateral interbody fusion significantly improves segmental, regional, and global coronal plane alignment in patients with degenerative lumbar disease. Although DLIF increases the segmental sagittal Cobb angle at the level of instrumentation, it does not improve regional lumbar lordosis or global sagittal alignment.

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

2013 ◽  
Vol 19 (1) ◽  
pp. 110-118 ◽  
Author(s):  
Luis Marchi ◽  
Nitamar Abdala ◽  
Leonardo Oliveira ◽  
Rodrigo Amaral ◽  
Etevaldo Coutinho ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Disc Height ◽  
Standard Group ◽  
Lateral Interbody Fusion ◽  
Cage Subsidence ◽  
Grade Ii ◽  
Wide Group ◽  
Lateral Interbody

Object Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. The influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. The authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale. Methods The study was performed as an institutional review board–approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%–24% loss of postoperative disc height; Grade I, 25%–49%; Grade II, 50%–74%; and Grade III, 75%–100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded. Results Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383). Conclusions Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.

scholarly journals Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis

2017 ◽  
Vol 26 (2) ◽  
pp. 150-157 ◽  
Author(s):  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Minori Kato ◽  
Tomonori Ozaki ◽  
Yusuke Hori ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Ct Imaging ◽  
Patient Questionnaire ◽  
Lumbar Interbody Fusion ◽  
Corrective Surgery ◽  
Sf 36 ◽  
Scoliosis Correction ◽  
The Mean

The purpose of this study was to assess the clinical results of posterior corrective surgery using a multilevel transforaminal lumbar interbody fusion (TLIF) with a rod rotation (RR) and to evaluate the segmental corrective effect of a TLIF using CT imaging. The medical records of 15 consecutive patients with degenerative lumbar kyphoscoliosis (DLKS) who had undergone posterior spinal corrective surgery using a multilevel TLIF with an RR technique and who had a minimum follow-up of 2 years were retrospectively reviewed. Radiographic parameters were evaluated using plain radiographs, and segmental correction was evaluated using CT imaging. Clinical outcomes were evaluated with the Scoliosis Research Society Patient Questionnaire-22 (SRS-22) and the SF-36. The mean follow-up period was 46.7 months, and the mean age at the time of surgery was 60.7 years. The mean total SRS-22 score was 2.9 before surgery and significantly improved to 4.0 at the latest follow-up. The physical functioning, role functioning (physical), and social functioning subcategories of the SF-36 were generally improved at the latest follow-up, although the changes in these scores were not statistically significant. The bodily pain, vitality, and mental health subcategories were significantly improved at the latest follow-up (p < 0.05). Three complications occurred in 3 patients (20%). The Cobb angle of the lumbar curve was reduced to 20.3° after surgery. The overall correction rate was 66.4%. The pelvic incidence–lumbar lordosis (preoperative/postoperative = 31.5°/4.3°), pelvic tilt (29.2°/18.9°), and sagittal vertical axis (78.3/27.6 mm) were improved after surgery and remained so throughout the follow-up. Computed tomography image analysis suggested that a 1-level TLIF can result in 10.9° of scoliosis correction and 6.8° of lordosis. Posterior corrective surgery using a multilevel TLIF with an RR on patients with DLKS can provide effective correction in the coronal plane but allows only limited sagittal correction.

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