- •
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.
Lateral Transpsoas Lumbar Interbody Fusion: Outcomes and Deformity Correction
Section snippets
Key points
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.
References (32)
- et al.
Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion
Spine J
(2006) - et al.
Biomechanics of lateral plate and pedicle screw constructs in lumbar spines instrumented at two levels with laterally placed interbody cages
Spine J
(2013) - et al.
Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease
J Clin Neurosci
(2013) - et al.
Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years
World Neurosurg
(2012) - et al.
Minimally invasive anterior retroperitoneal approach to the lumbar spine. Emphasis on the lateral BAK
Spine
(1998) - et al.
Biomechanical analysis and review of lateral lumbar fusion constructs
Spine
(2010) - et al.
Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications
Neurosurgery
(2011) - et al.
The effect of the retroperitoneal transpsoas minimally invasive lateral interbody fusion on segmental and regional lumbar lordosis
ScientificWorldJournal
(2012) - et al.
Sagittal alignment after lumbar interbody fusion: comparing anterior, lateral, and transforaminal approaches
J Spinal Disord Tech
(2013) - et al.
Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study
J Neurosurg Spine
(2011)
Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report
J Spinal Disord Tech
Clinical outcomes of extreme lateral interbody fusion in the treatment of adult degenerative scoliosis
ScientificWorldJournal
Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study
J Spinal Disord Tech
Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation
Neurosurg Focus
Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes
Neurosurg Focus
Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis
Neurosurg Focus
Cited by (0)
Sources of support: none.