Limits...
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

Postoperative lateral and AP views showing lateral interbody graft and posterior instrumentation.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4663280&req=5

fig2: Postoperative lateral and AP views showing lateral interbody graft and posterior instrumentation.

Mentions: A 47-year-old male presented with end-stage degenerative disc disease at L2/3 with associated severe back pain and bilateral lower extremity radiculopathy that had failed an extensive course of nonoperative management. Advanced imaging, including CT and MRI, revealed a grade 1 degenerative spondylolisthesis with associated facet arthrosis. Due to the collapse of the disc space, MRI demonstrated lateral recess and foraminal narrowing with neural stenosis but no acute herniated nucleus pulposus or severe ligamentum hypertrophy. Intraoperatively, the patient was placed in a right lateral decubitus position with the left flank and posterior dorsal spine prepped and draped in one setting. He underwent an L2/3 left lateral transpsoas discectomy and interbody fusion, followed by posterior percutaneous fixation without repositioning. Postoperative films were adequate (Figure 2), and he experienced no intraoperative or clinical complications.


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

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

Postoperative lateral and AP views showing lateral interbody graft and posterior instrumentation.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Postoperative lateral and AP views showing lateral interbody graft and posterior instrumentation.
Mentions: A 47-year-old male presented with end-stage degenerative disc disease at L2/3 with associated severe back pain and bilateral lower extremity radiculopathy that had failed an extensive course of nonoperative management. Advanced imaging, including CT and MRI, revealed a grade 1 degenerative spondylolisthesis with associated facet arthrosis. Due to the collapse of the disc space, MRI demonstrated lateral recess and foraminal narrowing with neural stenosis but no acute herniated nucleus pulposus or severe ligamentum hypertrophy. Intraoperatively, the patient was placed in a right lateral decubitus position with the left flank and posterior dorsal spine prepped and draped in one setting. He underwent an L2/3 left lateral transpsoas discectomy and interbody fusion, followed by posterior percutaneous fixation without repositioning. Postoperative films were adequate (Figure 2), and he experienced no intraoperative or clinical complications.

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