Cristiano Magalhães Menezes1, Todd Alamin2, Rodrigo Amaral3, Alexandry Dias Carvalho4, Roberto Diaz5, Alfredo Guiroy6, Khai S Lam7, Claudio Lamartina8, Alberto Perez-Contreras9, Yamil Rivera-Colon10, Willian Smith11, Nestor Taboada12, Jake Timothy13, Francesco Langella14, Pedro Berjano8. 1. Biocor/ Vila da Serra Hospital, Columna Institute, Belo Horizonte, Brazil. 2. Department of Orthopedic Surgery and Neurosurgery, Stanford University Medical Center, Redwood City, CA, USA. 3. Instituto de Patologia da Coluna (IPC), São Paulo, Brazil. 4. Hospital Universitário Do Piauí, Teresina, Brazil. 5. Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogotá, D.C, Colombia. 6. Elite Spine Health and Wellness Center, Fort Lauderdale, Florida, USA. 7. The London Bridge Hospital, London, UK. 8. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. 9. Director de Líderes en Cerebroy, Columna del Hospital Angeles del Pedregal, Ciudad de Mexico, Mexico. 10. Puerto Rico Spine Center, San Juan, Puerto Rico. 11. University Medical Center of Southern Nevada, Las Vegas, NV, USA. 12. Department of Neurosurgery, Clínica Portoazul, Barranquila, Colombia. 13. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 14. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. francesco.langella.md@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF). METHODS: A two-round Delphi method study was conducted to assess the consensus, within expert spine surgeons, regarding the perception of safety, the preoperative planning, the complications management and the need for vascular surgeons by performing anterior approaches (SupALIF vs LatALIF). RESULTS: A total of 14 experts voluntary were involved in the survey. From 82 sentences voted in the first round, a consensus was reached for 38 items. This included the feasibility of safe LatALIF without systematic involvement of vascular surgeon for routine cases (while for revision cases the involvement of the vascular surgeon is an appropriate option) and the appropriateness of standard MRI to evaluate the accessibility of the vascular window. Thirteen sentences reached the final consensus in the second round, whereas no consensus was reached for the remaining 20 statements. CONCLUSIONS: The Delphi study collected the consensus on several points, such as the consolidated required experience on anterior approaches, the accurate study of vascular anatomy with MRI, the management of complications and the significant reduction of the surgical times of the LatALIF if compared to SupALIF in combined procedures. Furthermore, the study group agrees that LatALIF can be performed without the need for a vascular surgeon in routine cases.
BACKGROUND AND PURPOSE: Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF). METHODS: A two-round Delphi method study was conducted to assess the consensus, within expert spine surgeons, regarding the perception of safety, the preoperative planning, the complications management and the need for vascular surgeons by performing anterior approaches (SupALIF vs LatALIF). RESULTS: A total of 14 experts voluntary were involved in the survey. From 82 sentences voted in the first round, a consensus was reached for 38 items. This included the feasibility of safe LatALIF without systematic involvement of vascular surgeon for routine cases (while for revision cases the involvement of the vascular surgeon is an appropriate option) and the appropriateness of standard MRI to evaluate the accessibility of the vascular window. Thirteen sentences reached the final consensus in the second round, whereas no consensus was reached for the remaining 20 statements. CONCLUSIONS: The Delphi study collected the consensus on several points, such as the consolidated required experience on anterior approaches, the accurate study of vascular anatomy with MRI, the management of complications and the significant reduction of the surgical times of the LatALIF if compared to SupALIF in combined procedures. Furthermore, the study group agrees that LatALIF can be performed without the need for a vascular surgeon in routine cases.
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