Kingsley R Chin1,2,3,4, Fabio J R Pencle5, Morgan D Brown5,6, Jason A Seale2,5. 1. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA. 2. Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA. 3. Less Exposure Surgery Specialists Institute (LESS Institute), Hollywood, FL, USA. 4. University of Technology, Kingston 6, Jamaica W.I. 5. Less Exposure Surgery (LES) Society, Malden, MA, USA. 6. Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: The technique of transpsoas lateral interbody fusion has been adopted to avoid direct anterior interbody fusion, but lateral fusions have been limited to disc spaces above L5 and are associated with neurologic injuries especially to the lumbar plexus when approaching L4-5. The authors aim to demonstrate a psoas splitting technique to decrease risk of complications associated with the standard transpsoas technique. METHODS: Medical records of 84 patients with prospectively collected data reviewed. Two groups created 44 patients with standard lateral transpsoas approach (group 1) and 40 patients with psoas splitting approach (group 2). The psoas splitting approach utilizes two blades placed anteriorly and posteriorly to split the psoas fibers anteriorly while keeping the posterior blade docked in place where it enters the psoas muscle. The cephalocaudal blades sit above the psoas muscle measuring 30-40 mm shorter than the posterior docking blade. RESULTS: Thirty-nine males and 45 females, age range 31-71 years, average 58±2 years. Average body mass index (BMI) was 28.4±1.1 kg/m2. Mean preoperative standard approach Oswestry disability index (ODI) increased from 48.4±3.0 to 55.2±4.0 compared to psoas splitting approach preoperative ODI means reduced from 45.1±5.0 to 34.9±6.0 (P=0.010). Group 1 mean preoperative visual analogue scale (VAS) score improved from 7.8±0.3 to 3.8±0.6 compared to group 2 mean preoperative VAS score which improved from 7.2±0.4 to 2.7±0.5 (P=0.048). Major complication rate of 20.5% was noted in standard transpsoas approach patients, including inability to walk and dermatome numbness. CONCLUSIONS: The outcomes of this study have shown that patients who had lateral lumbar interbody fusion (LLIF) with the psoas splitting approach had statistically significant improvement in ODI scores compared to the standard approach. Fusion was achieved in all patients and there was no evidence of implant failure or subsidence. In the psoas splitting group the major complication rate was only 5%.
BACKGROUND: The technique of transpsoas lateral interbody fusion has been adopted to avoid direct anterior interbody fusion, but lateral fusions have been limited to disc spaces above L5 and are associated with neurologic injuries especially to the lumbar plexus when approaching L4-5. The authors aim to demonstrate a psoas splitting technique to decrease risk of complications associated with the standard transpsoas technique. METHODS: Medical records of 84 patients with prospectively collected data reviewed. Two groups created 44 patients with standard lateral transpsoas approach (group 1) and 40 patients with psoas splitting approach (group 2). The psoas splitting approach utilizes two blades placed anteriorly and posteriorly to split the psoas fibers anteriorly while keeping the posterior blade docked in place where it enters the psoas muscle. The cephalocaudal blades sit above the psoas muscle measuring 30-40 mm shorter than the posterior docking blade. RESULTS: Thirty-nine males and 45 females, age range 31-71 years, average 58±2 years. Average body mass index (BMI) was 28.4±1.1 kg/m2. Mean preoperative standard approach Oswestry disability index (ODI) increased from 48.4±3.0 to 55.2±4.0 compared to psoas splitting approach preoperative ODI means reduced from 45.1±5.0 to 34.9±6.0 (P=0.010). Group 1 mean preoperative visual analogue scale (VAS) score improved from 7.8±0.3 to 3.8±0.6 compared to group 2 mean preoperative VAS score which improved from 7.2±0.4 to 2.7±0.5 (P=0.048). Major complication rate of 20.5% was noted in standard transpsoas approach patients, including inability to walk and dermatome numbness. CONCLUSIONS: The outcomes of this study have shown that patients who had lateral lumbar interbody fusion (LLIF) with the psoas splitting approach had statistically significant improvement in ODI scores compared to the standard approach. Fusion was achieved in all patients and there was no evidence of implant failure or subsidence. In the psoas splitting group the major complication rate was only 5%.
Entities:
Keywords:
Psoas splitting approach; inpatient; lateral lumbar interbody fusion (LLIF); less exposure surgery (LES); outcomes; outpatient; standard transpsoas approach
Authors: Jim A Youssef; Paul C McAfee; Catherine A Patty; Erin Raley; Spencer DeBauche; Erin Shucosky; Liana Chotikul Journal: Spine (Phila Pa 1976) Date: 2010-12-15 Impact factor: 3.468
Authors: Nicholas Clark; David F Schneider; Sara Vrabec; Philip S Bauer; Herbert Chen; Rebecca S Sippel Journal: J Surg Res Date: 2013-05-09 Impact factor: 2.192
Authors: Kingsley R Chin; Fabio J R Pencle; André V Coombs; Morgan D Brown; Kasey J Conklin; Andew M O'Neill; Michael J McGarry; Jason A Seale; Elijah A Hothem Journal: Spine (Phila Pa 1976) Date: 2016-04 Impact factor: 3.468