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Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations.

Drazin D, Kim TT, Johnson JP - Biomed Res Int (2015)

Bottom Line: Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position.In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning.Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

ABSTRACT
Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p = 0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photographs of Jamshidi needle placement (a) followed by posterior fixation (b) while in the lateral position.
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fig1: Intraoperative photographs of Jamshidi needle placement (a) followed by posterior fixation (b) while in the lateral position.

Mentions: The patient position remains unchanged for the second-stage posterior procedure. Implant selection for this technique is helpful as instrumenting a lateral decubitus patient requires an additional level of difficulty and spatial orientation. Recommendations are made to utilize MIS instrumentation systems that allow for “guided” insertion of the rod to the pedicle screw reduction towers. In our experience, for one- to three-level fusions, guided MIS rods (MIS Sextant, Medtronic Inc., Memphis, TN, and MIS Ballista, Biomet Inc., Warsaw, IN) offer the ability to insert percutaneous rods into pedicle screw reduction towers with ease and without significant soft tissue difficulty (Figures 1(a) and 1(b)). We recommend, however, any system with which the surgeon feels most comfortable.


Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations.

Drazin D, Kim TT, Johnson JP - Biomed Res Int (2015)

Intraoperative photographs of Jamshidi needle placement (a) followed by posterior fixation (b) while in the lateral position.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663280&req=5

fig1: Intraoperative photographs of Jamshidi needle placement (a) followed by posterior fixation (b) while in the lateral position.
Mentions: The patient position remains unchanged for the second-stage posterior procedure. Implant selection for this technique is helpful as instrumenting a lateral decubitus patient requires an additional level of difficulty and spatial orientation. Recommendations are made to utilize MIS instrumentation systems that allow for “guided” insertion of the rod to the pedicle screw reduction towers. In our experience, for one- to three-level fusions, guided MIS rods (MIS Sextant, Medtronic Inc., Memphis, TN, and MIS Ballista, Biomet Inc., Warsaw, IN) offer the ability to insert percutaneous rods into pedicle screw reduction towers with ease and without significant soft tissue difficulty (Figures 1(a) and 1(b)). We recommend, however, any system with which the surgeon feels most comfortable.

Bottom Line: Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position.In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning.Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

ABSTRACT
Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p = 0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

No MeSH data available.


Related in: MedlinePlus