Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 11 2022
01 11 2022
Historique:
received:
10
03
2022
accepted:
14
05
2022
pubmed:
14
10
2022
medline:
19
10
2022
entrez:
13
10
2022
Statut:
ppublish
Résumé
Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+). To report on the procedural steps and clinical outcomes of the SSLLIF+. In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented. A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion. SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.
Sections du résumé
BACKGROUND
Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).
OBJECTIVE
To report on the procedural steps and clinical outcomes of the SSLLIF+.
METHODS
In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.
RESULTS
A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.
CONCLUSION
SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.
Identifiants
pubmed: 36227239
doi: 10.1227/ons.0000000000000366
pii: 01787389-202211000-00009
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
406-412Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
Références
Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine (Phila Pa 1976). 1997;22(6):691-699; discussion 700.
Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435-443.
Elowitz EH, Yanni DS, Chwajol M, Starke RM, Perin NI. Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg. 2011;54(5-6):201-206.
Navarro-Ramirez R, Berlin C, Lang G, et al. A new volumetric radiologic method to assess indirect decompression after extreme lateral interbody fusion using high-resolution intraoperative computed tomography. World Neurosurg. 2018;109:59-67.
Hussain I, Fu KM, Uribe JS, Chou D, Mummaneni PV. State of the art advances in minimally invasive surgery for adult spinal deformity. Spine Deform. 2020;8(6):1143-1158.
Kirnaz S, Navarro-Ramirez R, Gu J, et al. Indirect decompression failure after lateral lumbar interbody fusion-reported failures and predictive factors: systematic review. Glob Spine J. 2020;10(2 suppl):8S-16S.
Lang G, Navarro-Ramirez R, Gandevia L, et al. Elimination of subsidence with 26-mm-wide cages in extreme lateral interbody fusion. World Neurosurg. 2017;104:644-652.
Lang G, Perrech M, Navarro-Ramirez R, et al. Potential and limitations of neural decompression in extreme lateral interbody fusion—a systematic review. World Neurosurg. 2017;101:99-113.
Alimi M, Lang G, Navarro-Ramirez R, et al. The impact of cage dimensions, positioning, and side of approach in extreme lateral interbody fusion. Clin Spine Surg. 2018;31(1):E42-E49.
Agha RA, Sohrabi C, Mathew G, et al. The PROCESS 2020 guideline: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int J Surg. 2020;84:231-235.
Schmidt FA, Navarro-Ramirez R, Chang L, Kirnaz S, Wipplinger C, Hartl R. Neural decompression in challenging cases: advantages and disadvantages. J Neurosurg Sci. 2019;63(5):541-547.
Aichmair A, Alimi M, Hughes AP, et al. Single-level lateral lumbar interbody fusion for the treatment of adjacent segment disease: a retrospective two-center study. Spine (Phila Pa 1976). 2017;42(9):E515-E522.
Boukebir MA, Berlin CD, Navarro-Ramirez R, et al. Ten-step minimally invasive spine lumbar decompression and dural repair through tubular retractors. Oper Neurosurg. 2017;13(2):232-245.
Limthongkul W, Tanasansomboon T, Yingsakmongkol W, Tanaviriyachai T, Radcliff K, Singhatanadgige W. Indirect decompression effect to central canal and ligamentum flavum after extreme lateral lumbar interbody fusion and oblique lumbar interbody fusion. Spine (Phila Pa 1976). 2020;45(17):E1077-E1084.
Batheja D, Dhamija B, Ghodke A, Anand SS, Balain BS. Lateral lumbar interbody fusion in adult spine deformity—a review of literature. J Clin Orthop Trauma. 2021;22:101597.
Li J, Li H, Zhang N, et al. Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study. BMC Musculoskelet Disord. 2020;21(1):259.
Barbagallo GM, Albanese V, Raich AL, Dettori JR, Sherry N, Balsano M. Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome. Evid Based Spine Care J. 2014;5(1):28-37.
Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus. 2002;13(2):E3.
Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022;376:e065846.
McCulloch P, Cook JA, Altman DG, Heneghan C, Diener MK, Group I. IDEAL framework for surgical innovation 1: the idea and development stages. BMJ. 2013;346:f3012.