Lateral Transpsoas Lumbar Interbody Fusion: Outcomes and Deformity Correction

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Key points

  • The lateral transpsoas approach for interbody fusion is a minimally invasive technique that has been successfully used in the treatment of a variety of spinal degenerative disorders.

  • There is growing evidence that this technique can be used in the management of adult deformity with good results and acceptable risks.

  • It is more powerful in correcting coronal deformity than sagittal deformity if used as the sole approach or technique.

Materials and methods

A computerized literature search of the National Library of Medicine’s database, Cochrane database, and Google Scholar was performed for published material between January 1966 and August 2013 using keywords and medical subject headings. The keywords included the following: lateral lumbar interbody fusion, direct lateral interbody fusion, extreme lateral interbody fusion, lateral transpsoas interbody fusion, DLIF (direct lateral interbody fusion), and XLIF (extreme lateral interbody fusion).

Results

Table 1 summarizes all 10 studies focusing on radiographic and clinical outcomes following lateral transpsoas interbody fusion for the correction of spinal deformity.

Anand and colleagues12 reported a series of 12 patients who underwent lateral interbody fusion and posterior percutaneous instrumentation for the treatment of adult scoliosis. They reported improvement of an average preoperative coronal Cobb angle of 18.9° to 6.1° postoperatively along with clinical improvement of Visual Analogue

Discussion

Minimally invasive spinal techniques have been gaining popularity as treatment options for a wide variety of degenerative, traumatic, and neoplastic spinal disorders.19, 20, 21 The hallmark of minimizing unnecessary muscle dissection, soft tissue damage, and trauma has unequivocally translated into lesser wound infections, blood loss, cerebrospinal fluid leaks, hospital stay, and even cost-effectiveness, while maintaining similar long-term outcomes.22, 23, 24, 25 With the recent development of

Complications

The complications of the lateral transpsoas approach are well documented. Most of the complications are related to lumbar plexus injuries. These complications most commonly manifest as anterolateral thigh or groin pain and or numbness and also weakness with the ipsilateral iliopsoas or quadriceps. The frequency of thigh numbness postoperatively ranges from 17.8% to more than 40.0% immediately postoperatively.29, 30, 31 Weakness ranges from 25.0% to 54.9%.30, 32 Most reports agree that symptoms

Summary

Lateral transpsoas lumbar interbody fusion is a minimally invasive option for the correction of degenerative scoliosis. Evidence suggests that adequate radiographic correction and improved clinical outcomes can be achieved using this approach.

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    Clinical outcomes of extreme lateral interbody fusion in the treatment of adult degenerative scoliosis

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    Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

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