Dominik Adl Amini1,2, Manuel Moser1, Lisa Oezel1,3, Jiaqi Zhu1, Jennifer Shue1, Andrew A Sama1, Frank P Cammisa1, Federico P Girardi1, Alexander P Hughes4. 1. Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA. 2. Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany. 3. Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. 4. Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA. hughesa@hss.edu.
Abstract
PURPOSE: To develop a decision-making pathway for primary SA-LLIF. Furthermore, we analyzed the agreement of this pathway and compared outcomes of patients undergoing either SA-LLIF or 360-LLIF. METHOD: A decision-making pathway for SA-LLIF was created based on the results of interviews/surveys of senior spine surgeons with over 10 years of experience. Internal validity was retrospectively evaluated using consecutive patients undergoing either SA-LLIF or 360-LLIF between 01/2018 and 07/2020 with 3D-printed Titanium cages. An outcome assessment looking primarily at revision surgery and secondary at cage subsidence, changes in disk and foraminal height, global and segmental lumbar lordosis, duration of surgery, estimated blood loss, and length of stay was carried out. RESULTS: 78 patients with 124 treated levels (37 SA-LLIF, 41 360-LLIF) were retrospectively analyzed. The pathway showed a direct agreement (SA-LLIF) of 100.0% and an indirect agreement (360-LLIF) of 95.1%. Clinical follow-up averaged 13.5 ± 6.5 months including 4 revision surgeries in the 360-LLIF group and none in the SA-LLIF group (p = 0.117). Radiographic follow-up averaged 9.5 ± 4.3 months, with no statistically significant difference in cage subsidence rate between the groups (p = 0.440). Compared to preoperative images, patients in both groups showed statistically significant changes in disk height (p < 0.001), foraminal height (p < 0.001), as well as restoration of segmental lordosis (p < 0.001 and p = 0.018). The SA-LLIF group showed shorter duration of surgery, less estimated blood loss and shorter LOS (p < 0.001). CONCLUSION: The proposed decision-making pathway provides a guide to adequately select patients for SA-LLIF. Further studies are needed to assess the external applicability and validity. LEVEL OF EVIDENCE III: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: To develop a decision-making pathway for primary SA-LLIF. Furthermore, we analyzed the agreement of this pathway and compared outcomes of patients undergoing either SA-LLIF or 360-LLIF. METHOD: A decision-making pathway for SA-LLIF was created based on the results of interviews/surveys of senior spine surgeons with over 10 years of experience. Internal validity was retrospectively evaluated using consecutive patients undergoing either SA-LLIF or 360-LLIF between 01/2018 and 07/2020 with 3D-printed Titanium cages. An outcome assessment looking primarily at revision surgery and secondary at cage subsidence, changes in disk and foraminal height, global and segmental lumbar lordosis, duration of surgery, estimated blood loss, and length of stay was carried out. RESULTS: 78 patients with 124 treated levels (37 SA-LLIF, 41 360-LLIF) were retrospectively analyzed. The pathway showed a direct agreement (SA-LLIF) of 100.0% and an indirect agreement (360-LLIF) of 95.1%. Clinical follow-up averaged 13.5 ± 6.5 months including 4 revision surgeries in the 360-LLIF group and none in the SA-LLIF group (p = 0.117). Radiographic follow-up averaged 9.5 ± 4.3 months, with no statistically significant difference in cage subsidence rate between the groups (p = 0.440). Compared to preoperative images, patients in both groups showed statistically significant changes in disk height (p < 0.001), foraminal height (p < 0.001), as well as restoration of segmental lordosis (p < 0.001 and p = 0.018). The SA-LLIF group showed shorter duration of surgery, less estimated blood loss and shorter LOS (p < 0.001). CONCLUSION: The proposed decision-making pathway provides a guide to adequately select patients for SA-LLIF. Further studies are needed to assess the external applicability and validity. LEVEL OF EVIDENCE III: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Authors: Marco T Reis; Phillip M Reyes; Idris Altun; Anna G U S Newcomb; Vaneet Singh; Steve W Chang; Brian P Kelly; Neil R Crawford Journal: J Neurosurg Spine Date: 2016-07-08
Authors: Dean Chou; Gregory Mundis; Michael Wang; Kai-Ming Fu; Christopher Shaffrey; David Okonkwo; Adam Kanter; Robert Eastlack; Stacie Nguyen; Vedat Deviren; Juan Uribe; Richard Fessler; Pierce Nunley; Neel Anand; Paul Park; Praveen Mummaneni Journal: World Neurosurg Date: 2019-04-01 Impact factor: 2.104
Authors: Colleen Rentenberger; Ichiro Okano; Stephan N Salzmann; Fabian Winter; Nicolas Plais; Marco D Burkhard; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Alexander P Hughes Journal: World Neurosurg Date: 2019-11-04 Impact factor: 2.104
Authors: Zachary J Tempel; Michael M McDowell; David M Panczykowski; Gurpreet S Gandhoke; D Kojo Hamilton; David O Okonkwo; Adam S Kanter Journal: J Neurosurg Spine Date: 2017-11-10
Authors: Nitin Agarwal; Andrew Faramand; Nima Alan; Zachary J Tempel; D Kojo Hamilton; David O Okonkwo; Adam S Kanter Journal: J Neurosurg Spine Date: 2018-11-01
Authors: Dominik Adl Amini; Manuel Moser; Lisa Oezel; Jiaqi Zhu; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Alexander P Hughes Journal: Eur Spine J Date: 2021-10-28 Impact factor: 2.721