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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

Graph of estimated blood loss and operative time in repositioned versus nonrepositioned patients.
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fig3: Graph of estimated blood loss and operative time in repositioned versus nonrepositioned patients.

Mentions: Between March 2010 and November 2011, twenty patients underwent lateral interbody fusion followed by posterior percutaneous screw fixation followed for an average of 9 months (range 6 months–12 months). The nonrepositioned group included 3 women and 7 men, while the repositioned group included 6 women and 4 men. The average age was 54.5 years (range 30–78, nonrepositioned) and 57.8 years (range 45–71, repositioned). Avoiding repositioning, operative time from incision to closure averaged 130.5 minutes (versus repositioned 190.3 minutes; p < 0.05) and intraoperative blood loss was 108 mL (versus 93 mL; NS, Figure 3). Nonrepositioned patients were hospitalized for an average of 3.8 days (versus 4.1 days; NS). Details of patients' characteristics are outlined in Table 1. Of the twenty patients who underwent surgery, there were 3 patients (2 in repositioned and 1 in nonrepositioned) who experienced transient (less than 2 weeks) postoperative numbness on the side they had the lateral interbody fusion. No patient, in either group, reported weakness or significant pain related to the approach from the postoperative period through the most recent follow-up. Postoperative imaging confirmed appropriate positioning of the hardware; however one patient in the repositioned cohort required screw repositioning.


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

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

Graph of estimated blood loss and operative time in repositioned versus nonrepositioned patients.
© Copyright Policy
Related In: Results  -  Collection

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

fig3: Graph of estimated blood loss and operative time in repositioned versus nonrepositioned patients.
Mentions: Between March 2010 and November 2011, twenty patients underwent lateral interbody fusion followed by posterior percutaneous screw fixation followed for an average of 9 months (range 6 months–12 months). The nonrepositioned group included 3 women and 7 men, while the repositioned group included 6 women and 4 men. The average age was 54.5 years (range 30–78, nonrepositioned) and 57.8 years (range 45–71, repositioned). Avoiding repositioning, operative time from incision to closure averaged 130.5 minutes (versus repositioned 190.3 minutes; p < 0.05) and intraoperative blood loss was 108 mL (versus 93 mL; NS, Figure 3). Nonrepositioned patients were hospitalized for an average of 3.8 days (versus 4.1 days; NS). Details of patients' characteristics are outlined in Table 1. Of the twenty patients who underwent surgery, there were 3 patients (2 in repositioned and 1 in nonrepositioned) who experienced transient (less than 2 weeks) postoperative numbness on the side they had the lateral interbody fusion. No patient, in either group, reported weakness or significant pain related to the approach from the postoperative period through the most recent follow-up. Postoperative imaging confirmed appropriate positioning of the hardware; however one patient in the repositioned cohort required screw repositioning.

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