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Flank incisional hernia after lateral approach spine operations: presentation and outcomes after repair. Surg Endosc 2021; 36:2138-2145. [PMID: 33825011 DOI: 10.1007/s00464-021-08450-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The flank approach to lumbar spine surgery is considered a new minimally invasive alternative to the anterior abdominal approach. Flank incisional hernia is one complication, but it has been poorly studied. METHODS Retrospective review of patients referred for evaluation of abdominal bulging after Lateral Interbody Fusion (LIF), 2013-2020. RESULTS Seventeen patients were evaluated for abdominal bulging after LIF: 14 were diagnosed with incisional hernias. Three with denervation injury without hernia defect were excluded. CONCLUSIONS This is the largest study addressing incisional flank hernias after LIF, an under-represented complication in the spine literature. We show that the patients present early, within months of their operation, and yet most hernias are not diagnosed for over a year. Although LIF is considered a minimally invasive procedure, the morbidity from hernia complications cannot be overlooked. These flank hernias are difficult to repair with suboptimal outcomes. We prefer robotic approach with primary closure of the defect and extraperitoneal sublay mesh, whenever possible. Prevention is key. To help reduce risk of hernia, we recommend closure of all muscle layers with slowly absorbable suture; this is different than was originally described in the spine literature.
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Incisional hernia after extreme lateral interbody fusion on the lumbar spine: A case report. Int J Surg Case Rep 2020; 78:130-132. [PMID: 33340980 PMCID: PMC7750124 DOI: 10.1016/j.ijscr.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Extreme lateral interbody fusion is a minimally invasive lateral transpsoas approach for spine surgery. We herein report a case of an incisional hernia after an extreme lateral interbody fusion on the lumbar spine that was successfully treated by laparoscopic surgery with intraperitoneal onlay mesh repair. PRESENTATION OF CASE A 78-year-old woman was referred to our hospital with a complaint of left abdominal bulge and pain. She had undergone an extreme lateral interbody fusion for a lumbar spinal canal stenosis from L1 to L4 a year prior. Abdominal computerized tomography showed a left lumbar incisional hernia, and laparoscopic surgery was performed. The hernia orifice was sutured closed and covered with mesh. The patient was discharged five days after the operation with no complications. DISCUSSION When performing XLIF for a spinal disorder, the muscles should be separated bluntly along their fibers to prevent muscle atrophy, and the incised fascia should be securely sutured closed. Abdominal wall incisional hernias can occur after spinal surgeries such as extreme lateral interbody fusion. CONCLUSION Laparoscopic repair for abdominal wall incisional hernia after spine surgery is safe and feasible.
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Lateral Lumbar Interbody Fusion: Review of Surgical Technique and Postoperative Multimodality Imaging Findings. AJR Am J Roentgenol 2020; 217:480-494. [PMID: 32903050 DOI: 10.2214/ajr.20.24074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The lateral lumbar interbody fusion (LLIF) approach is a minimally invasive surgery that can be used as an alternative to traditional lumbar interbody fusion techniques. LLIF accesses the intervertebral disk through the retroperitoneum and psoas muscle to avoid major vessels and visceral organs. The exposure of retroperitoneal structures during LLIF leads to unique complications compared with other surgical approaches. An understanding of the surgical technique and its associated potential complications is necessary for radiologists who interpret imaging before and after LLIF. Preoperative imaging must carefully assess the location of anatomic structures, including major retroperitoneal vasculature, lumbar nerve roots, lumbosacral plexus, and the genitofemoral nerve, relative to the psoas muscle. Multiple imaging modalities can be used in postoperative assessment including radiographs, CT, CT myelography, and MRI. Of these, CT is the preferred modality, because it can assess a range of complications relating to both the retroperitoneal exposure and the spinal instrumentation, as well as bone integrity and fusion status. This article describes surgical approaches for lumbar interbody fusion, comparing the approaches' indications, contraindications, advantages, and disadvantages; reviews the surgical technique of LLIF and relevant anatomic considerations; and illustrates for interpreting radiologists the normal postoperative findings and potential postsurgical complications of LLIF.
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Bilateral Lumbar Hernias Following Spine Surgery: A Case Report and Laparoscopic Transabdominal Repair. Case Rep Surg 2020; 2020:8859106. [PMID: 32802549 PMCID: PMC7415095 DOI: 10.1155/2020/8859106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023] Open
Abstract
Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.
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Vivas AC, Januszewski J, Hajirawala L, Paluzzi JM, Gandhi SV, Uribe JS. Incisional Hernia After Minimally Invasive Lateral Retroperitoneal Surgery: Case Series and Review of the Literature. Oper Neurosurg (Hagerstown) 2019; 16:368-373. [PMID: 29718425 DOI: 10.1093/ons/opy089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/26/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive lateral retroperitoneal (lateral-MIS) approaches to the spine involve traversing the lateral abdominal wall musculature and fascia. Incisional hernia is an uncommon approach-related complication. OBJECTIVE To review the incidence, treatment, and preventative measures of incisional hernia after lateral-MIS approaches. METHODS This is a retrospective review of cases performed by a single surgeon from 2011 to 2016. All patients who underwent lateral-MIS approaches at this institution were included. Patients with a postoperative diagnosis of lateral hernia on physical exam and corroborating advanced imaging findings were included in this study. Cases of flank bulge due to peripheral nerve injury were excluded. RESULTS Three-hundred three patients underwent lateral-MIS approaches to the spine. Three (1%) patients with incisional hernia were identified. Two patients presented with a clinically symptomatic incisional hernia, while 1 patient was diagnosed incidentally after a routine abdominal magnetic resonance imaging for an unrelated reason. No patients suffered bowel entrapment or strangulation. CONCLUSION Incisional hernia after lateral-MIS approaches is rare. Patients with incisional hernias may be susceptible to bowel incarceration and ischemia, though the incidence of this is probably low. Meticulous closure of the fascia is critical to avoiding this complication.
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Affiliation(s)
- Andrew C Vivas
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jacob Januszewski
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Luv Hajirawala
- Department of Surgery, LSU Health Sciences, New Orleans, Louisianna
| | - Jason M Paluzzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Shashank V Gandhi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Juan S Uribe
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
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Gundanna M, Shah K. Delayed Incisional Hernia Following Minimally Invasive Trans-Psoas Lumbar Spine Surgery: Report of a Rare Complication and Management. Int J Spine Surg 2018; 12:126-130. [PMID: 30276071 DOI: 10.14444/5019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Lateral lumbar interbody fusion (LLIF) has proved to be a safe tool in the armamentarium of spine surgeons for a variety of lumbar disorders. However, it has some complications related to specific approaches. Incisional hernia following abdominal surgery and anterior spinal surgery is commonly described; however, it is extremely rare following LLIF, with only 1 case reported in short postoperative period. In this report we present the first case of delayed presentation of true incisional hernia following a LLIF procedure and highlight its presentation, mechanism, possible preventive measures, and management. Methods We report a 57-year-old lady who underwent L3-4 LLIF. She presented with vague pain in a healed scar area that had no swelling until two years postsurgery, when she developed a painful swelling. On examination, it appeared to be a herniation of abdominal contents. Results She underwent a laparoscopic hernia repair surgery. The muscular layers were found to be intact with an attenuated transversalis fascia layer. The repair was reinforced by polypropylene mesh. There was no recurrence at the 6-month follow-up. Conclusions Incisional hernia can occur following LLIF months to years following surgery and can have varied presentation. Tight external oblique closure should be performed because the transversalis fascia often cannot be repaired and the quality of a layered closure of the deep obliques is often disappointing. The treating surgeon should be aware of this complication and aggressively surveil for the warning signs, and patients should be counseled about this potential complication.
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Liu G, Liu S, Zuo YZ, Li QY, Wu ZH, Wu N, Yu KY, Qiu GX. Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis. Chin Med J (Engl) 2018; 130:2608-2615. [PMID: 28799527 PMCID: PMC5678262 DOI: 10.4103/0366-6999.212688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: “minimally invasive,” “spine,” “surgery,” and “scoliosis.” Study Selection: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. Conclusions: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Sen Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
| | - Yu-Zhi Zuo
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qi-Yi Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhi-Hong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity; Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Nan Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
| | - Ke-Yi Yu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing 100730, China
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DiGiorgio AM, Edwards CS, Virk MS, Mummaneni PV, Chou D. Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series. Neurosurg Focus 2018; 43:E14. [PMID: 28760040 DOI: 10.3171/2017.5.focus17168] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior lumbar interbody fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral lumbar interbody fusion in a series of 49 patients.
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Affiliation(s)
- Anthony M DiGiorgio
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and.,Department of Neurosurgery and
| | - Caleb S Edwards
- School of Medicine, University of California, San Francisco, California
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Alonso F, Graham R, Rustagi T, Drazin D, Loukas M, Oskouian RJ, Chapman JR, Tubbs RS. The Subcostal Nerve During Lateral Approaches to the Lumbar Spine: An Anatomical Study with Relevance for Injury Avoidance and Postoperative Complications Such as Abdominal Wall Hernia. World Neurosurg 2017; 104:669-673. [DOI: 10.1016/j.wneu.2017.05.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
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Suratwala SJ, Cronin M, Kondra K, Leone V. Acute Renal Infarction After Lateral Lumbar Interbody Spinal Fusion for Kyphoscoliosis. Spine Deform 2016; 4:385-389. [PMID: 27927497 DOI: 10.1016/j.jspd.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 03/21/2016] [Accepted: 04/03/2016] [Indexed: 01/04/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVES Case report of acute renal infarction following lateral interbody fusion with posterior instrumentation for adult lumbar kyphoscoliosis. SUMMARY OF BACKGROUND DATA This is the first reported renal infarction following minimally invasive lateral interbody fusion and posterior spinal instrumentation. METHODS We report a case of acute renal infarction in a 72-year-old woman following direct lateral interbody fusion (DLIF) with percutaneous pedicle screw and rod fixation from L1 to L5 for correction of kyphoscoliosis. She reported vague abdominal pain on postoperative day (POD) 7. Abdominal ultrasound findings revealed no abnormalities. The patient tolerated a regular diet, improved in rehabilitative modalities, and had stable vital signs. Abdominal computed tomographic (CT) scan on POD 9 for persistent abdominal pain revealed right renal infarction and right renal artery occlusion. The patient was transferred to the ICU for evaluation, where intravenous heparin was administered and no reperfusion was performed. Transesophageal echocardiography on POD 14 revealed moderate diffuse plaque in the descending aorta. RESULTS Surgical correction of kyphoscoliosis through DLIF and posterior spinal instrumentation was performed with improvement of deformity. Subsequent acute renal infarction was noted. The patient was discharged home on POD 21. There were no further adverse events up to the 1-year follow-up. CONCLUSIONS A lateral approach to the anterior lumbar spine may precipitate renal artery occlusion and renal infarction in patients with atherosclerosis. Diagnosis of renal infarction requires a high index of suspicion because the primary complaint may be vague back, flank, and abdominal pain. We emphasize the importance of recognizing potential symptoms early to prevent additional renal injury. Caution should be taken with deformities around the origin of the renal arteries and great vessels, especially in patients with atherosclerosis. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sanjeev J Suratwala
- Northwell Health, Glen Cove and Syosset Hospitals, New York Orthopaedic and Spine Center, 833 Northern Boulevard, Suite 220, Great Neck, NY 11021, USA.
| | - MaryAnne Cronin
- Northwell Health, Glen Cove and Syosset Hospitals, Syosset Hospital, 221 Jericho Turnpike, Syosset, NY 11791, USA
| | - Katelyn Kondra
- Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Vincent Leone
- Northwell Health, Glen Cove and Syosset Hospitals, New York Orthopaedic and Spine Center, 833 Northern Boulevard, Suite 220, Great Neck, NY 11021, USA
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Plata-Bello J, Roldan H, Brage L, Rahy A, Garcia-Marin V. Delayed Abdominal Pseudohernia in Young Patient After Lateral Lumbar Interbody Fusion Procedure: Case Report. World Neurosurg 2016; 91:671.e13-6. [DOI: 10.1016/j.wneu.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022]
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MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:287-313. [DOI: 10.1007/s00586-015-3886-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
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Koreckij T, Park DK, Fischgrund J. Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma. Neurosurg Focus 2015; 37:E11. [PMID: 24981899 DOI: 10.3171/2014.5.focus1494] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracolumbar and lumbar trauma account for the majority of traumatic spinal injuries. The mainstay of current treatments is still nonoperative therapy with bracing. Classic treatment algorithms reserved absolute surgical intervention for spinal trauma patients with neurological compromise or instability. Relative indications included incapacitating pain and obesity/body habitus making brace therapy ineffective. In the past decade, minimally invasive surgical (MIS) techniques for spine surgery have been increasingly used for degenerative conditions. These same minimally invasive techniques have seen increased use in trauma patients. The goal of minimally invasive surgery is to decrease surgical morbidity through decreased soft-tissue dissection while providing the same structural stability afforded by classic open techniques. These minimally invasive techniques involve percutaneous posterior pedicle fixation, vertebral body augmentation, and utilization of endoscopic and thoracoscopic techniques. While MIS techniques are somewhat in their infancy, an increasing number of studies are reporting good clinical and radiographic outcomes with these MIS techniques. However, the literature is still lacking high-quality evidence comparing these newer techniques to classic open treatments. This article reviews the relevant literature regarding minimally invasive spine surgery in the treatment of thoracolumbar and lumbar trauma.
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Affiliation(s)
- Theodore Koreckij
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan
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Williams SK. Indirect decompression for lumbar spinal stenosis with the minimally invasive lateral approach. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.semss.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Anand N, Baron EM. Urological injury as a complication of the transpsoas approach for discectomy and interbody fusion. J Neurosurg Spine 2013; 18:18-23. [DOI: 10.3171/2012.9.spine12659] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transpsoas discectomy and interbody fusion has become an increasingly popular method of achieving lumbar interbody fusion, but reports of neurological, vascular, and gastrointestinal complications associated with this procedure have been described in the literature. To date, however, ureteral complications have not been reported with this procedure. The authors report 2 cases of ureteral injury and 1 case of renal injury following this procedure. A low index of suspicion is warranted to work up any patient having flank or abdominal symptoms after undergoing transpsoas discectomy and interbody fusion.
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Affiliation(s)
| | - Eli M. Baron
- 2Neurosurgery, Cedars-Sinai Spine Center, Los Angeles, California
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Patel VC, Park DK, Herkowitz HN. Lateral transpsoas fusion: indications and outcomes. ScientificWorldJournal 2012; 2012:893608. [PMID: 23213303 PMCID: PMC3504425 DOI: 10.1100/2012/893608] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/14/2012] [Indexed: 11/17/2022] Open
Abstract
Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.
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Affiliation(s)
- Vishal C Patel
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
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