Neel Anand1, Alisa Alayan2, Aniruddh Agrawal3, Sheila Kahwaty1, Edward Nomoto1, Babak Khandehroo1. 1. Spine Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Spine Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: alisa.alayan@gmail.com. 3. Topiwala National Medical College, Mumbai, India.
Abstract
BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019. Sixty patients had ≥4 levels fused and OLIF 5-1. Multilevel pre-psoas LIF + OLIF 5-1 were performed in the first stage. Three days later, stage 2 involved MIS installation of pedicle screws with aggressive rod contouring and derotation/translation. RESULTS: The mean patient age was 66.8 years (range, 48-79 years), and the mean duration of follow-up was 24 months (range, 3-60 months). A mean of 7 levels were fused (range, 4-9). Significant improvements in L5-S1 segmental lordosis (SL), LL, SVA, PI-LL mismatch, and pelvic tilt were seen following the first stage (P < 0.05). There was no intraoperative vascular, ureteral, or sympathetic chain injury, and no transient or permanent lumbar plexopathy. In 2 patients, OLIF 5-1 was abandoned due to difficult access, and transforaminal LIF was done at L5-S1 at the second stage. Five patients required intraoperative transfusion. No patient experienced postoperative ileus or L5-S1 pseudarthrosis. Significant improvements in visual analog scale pain score, Oswestry Disability Index, 36-Item Short Form Health Survey, and Scoliosis Research Society Outcomes Questionnaire were found. CONCLUSIONS: A single-position MIS OLIF 5-1 at the bottom of a long construct in conjunction with multilevel pre-psoas LIF seems to be a safe and effective technique for improving SL, global LL, and SVA with a low risk of perioperative and postoperative complications.
BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019. Sixty patients had ≥4 levels fused and OLIF 5-1. Multilevel pre-psoas LIF + OLIF 5-1 were performed in the first stage. Three days later, stage 2 involved MIS installation of pedicle screws with aggressive rod contouring and derotation/translation. RESULTS: The mean patient age was 66.8 years (range, 48-79 years), and the mean duration of follow-up was 24 months (range, 3-60 months). A mean of 7 levels were fused (range, 4-9). Significant improvements in L5-S1 segmental lordosis (SL), LL, SVA, PI-LL mismatch, and pelvic tilt were seen following the first stage (P < 0.05). There was no intraoperative vascular, ureteral, or sympathetic chain injury, and no transient or permanent lumbar plexopathy. In 2 patients, OLIF 5-1 was abandoned due to difficult access, and transforaminal LIF was done at L5-S1 at the second stage. Five patients required intraoperative transfusion. No patient experienced postoperative ileus or L5-S1 pseudarthrosis. Significant improvements in visual analog scale pain score, Oswestry Disability Index, 36-Item Short Form Health Survey, and Scoliosis Research Society Outcomes Questionnaire were found. CONCLUSIONS: A single-position MIS OLIF 5-1 at the bottom of a long construct in conjunction with multilevel pre-psoas LIF seems to be a safe and effective technique for improving SL, global LL, and SVA with a low risk of perioperative and postoperative complications.
Authors: Alexander O Aguirre; Mohamed A R Soliman; Shady Azmy; Asham Khan; Patrick K Jowdy; Jeffrey P Mullin; John Pollina Journal: Neurosurg Rev Date: 2021-12-01 Impact factor: 3.042