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Godolias P, Frieler S, Tataryn ZL, McBride P, Nunna R, Ghayoumi P, Charlot K, Tran A, Al-Awadi H, Gerstmeyer JR, Ruetten S, Chapman JR, Oskouian RJ. Towards a More Realistic Appraisal of Complications Following Staged Lateral Lumbar Interbody Fusion: A Single Institution Series. Global Spine J 2024; 14:130-137. [PMID: 35446693 PMCID: PMC10676158 DOI: 10.1177/21925682221096621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort. METHODS This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery. RESULTS The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days). CONCLUSIONS We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.
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Affiliation(s)
- Periklis Godolias
- Seattle Science Foundation, Seattle, WA, USA
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sven Frieler
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | | | | | - Ravi Nunna
- Seattle Science Foundation, Seattle, WA, USA
| | | | | | - Angela Tran
- Seattle Science Foundation, Seattle, WA, USA
| | | | - Julius R. Gerstmeyer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group–Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital/Marien Hospital Witten, Herne, Germany
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Lumbosacral plexus 3D printing with dissection validation - a baseline study with regards to lateral spine surgery. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Godolias P, Tataryn ZL, Frieler S, Nunna R, Charlot K, Tran A, Plümer J, Cibura C, Al-Awadi H, Daher Z, Dudda M, Schildhauer TA, Chapman J, Oskouian R. Complication rates following stand-alone lateral interbody fusion: a single institution series after 10 years of experience. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03408-7. [PMID: 36239820 DOI: 10.1007/s00590-022-03408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This retrospective single institution study's goal was to analyze and report the complications from stand-alone lateral lumbar interbody fusions (LLIF). METHODS This research was approved by the institutional review board (STUDY2021000113). We retrospectively reviewed the database of patients with adult degenerative spine deformity treated via LLIF at our institution between January 2016 and December 2020. RESULTS Stand-alone LLIF was performed in 158 patients (145 XLIF, 13 OLIF; mean age 65 y.; 88 f., 70 m.). Mean surgical time was 85 min (± 24 min). Mean follow-up was 14 months (± 5 m). Surgical blood loss averaged 120 mL (± 187 mL) and the mean number of fused levels was 1.2 (± 0.4 levels). Overall complication rate was 19.6% (31 total; 23 approach-related, 8 secondary complications). CONCLUSION Lateral interbody fusion appears to be a safe surgical intervention with relatively low complication- and revision rates.
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Affiliation(s)
- Periklis Godolias
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Propsteistrasse 2, 45239, Essen, Germany.
| | - Zachary L Tataryn
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Sven Frieler
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ravi Nunna
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Kaarina Charlot
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Angela Tran
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Jonathan Plümer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Charlotte Cibura
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hamzah Al-Awadi
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Zeyad Daher
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Marcel Dudda
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas A Schildhauer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jens Chapman
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
| | - Rod Oskouian
- Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA
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Pan B, Yu W, Lou C, Gao J, Huang W, He D. Comparison of mini-open, anteroinferior psoas approach and mini-open, direct lateral transpsoas approach for lumbar burst fractures: A retrospective cohort study. Front Surg 2022; 9:995410. [PMID: 36311940 PMCID: PMC9614075 DOI: 10.3389/fsurg.2022.995410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We evaluated the effect of a novel modified OLIF technique (anteroinferior psoas approach, AIPA) for anterior decompression reconstruction in lumbar burst fractures, and compared the clinical, radiological outcomes and approach-related complications with the mini-open, lateral transpsoas approach (LTPA). METHODS From March 2016 to November 2019, 68 patients with lumbar burst fractures underwent one-stage monosegmental posterior/anterior surgery from L1-L4 segments. 35 patients included in AIPA and 33 patients in LTPA group underwent anterior decompression reconstruction. The clinical, radiological and functional evaluation outcomes were recorded during the 16-60 months follow-up period. RESULTS At the latest follow up, neurological state of one or more ASIA grades were achieved in AIPA (90.9%) and LTPA group (94.9%). No significant differences were noted between the two groups regarding preoperative and postoperative Cobbs angle. The surgery time (192.29 vs. 230.47 min, P = 0.02) in AIPA group was better compared with LTPA. The AIPA showed better improvement on Oswestry Disability Index (43.4% vs. 60.8%, P < 0.05) and Mental Component Score (49.0% vs. 43.7%, P < 0.05) one month after surgery, but no difference at the latest follow-up. 10 patients (9 in LTPA and 1 in AIPA) experienced temporary motor deficits in hip flexor and groin or thigh numbness, which disappeared six months after surgery. CONCLUSIONS Compared with lateral transpsoas approach, anterior decompression reconstruction via mini-open, anteroinferior psoas approach was a safe and less invasive approach, with fewer approach-related complications in the treatment for unstable lumbar burst fractures.
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Von Glinski A, Elia CJ, Takayanagi A, Yilmaz E, Ishak B, Dettori J, Schell BA, Hayman E, Pierre C, Chapman JR, J.Oskouian R. Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma. Global Spine J 2021; 11:515-524. [PMID: 32875932 PMCID: PMC8119928 DOI: 10.1177/2192568220914883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Complication profiles for lateral approaches to the spine are well established. However, the influence of level of surgery on complication rates and subtypes are less well established. To determine risk factors for complications as determined by level and surgery type in patients undergoing a lateral (retroperitoneal or retropleural approach) to the thoracolumbar spine. METHODS All adult patients undergoing a lateral thoracolumbar fusion with or without posterior instrumentation performed at a single institution were identified. Primary outcomes assessed were presence of complication, complication subtype, and need for reoperation. The primary independent variables were spinal level (thoracic, thoracolumbar, or lumbar) and type of surgery (discectomy or corpectomy). Categorical outcomes were compared using chi-square test. Unadjusted and adjusted odds ratios for corpectomy status were calculated to determine risk of complication by level. P < .05 was considered statistically significant. RESULTS A total of 165 patients aged 18 to 75 years were identified as having undergone a lateral fusion. Complication rates were 28.6%, 36.4%, and 11% for thoracic, thoracolumbar, and lumbar lateral approach fusions, respectively. Under univariate analysis, patients undergoing lateral approach in the thoracic spine group had significantly higher rates of postoperative complications than those in the lumbar group (P = .005). After adjusting for corpectomy status, there was no difference in complication rates. CONCLUSIONS Lateral (retroperitoneal or retropleural) approaches to the thoracic and thoracolumbar spine may be used with complication rates comparable to well-established lumbar approaches. Extent of surgery (corpectomy vs discectomy) rather than level of surgery may represent the primary driver of complications.
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Affiliation(s)
- Alexander Von Glinski
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum,
Bochum, Germany,Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA,
USA,Alexander Von Glinski, Seattle Science
Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98122, USA.
| | - Christopher J. Elia
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA,Riverside University Health
Systems, Moreno Valley, CA, USA
| | | | - Emre Yilmaz
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum,
Bochum, Germany
| | - Basem Ishak
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | | | - Benjamin A. Schell
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA
| | - Erik Hayman
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA
| | - Clifford Pierre
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | - Jens R. Chapman
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
| | - Rod J.Oskouian
- Swedish Neuroscience
Institute, Swedish Medical Center, Seattle, WA, USA,Seattle Science Foundation, Seattle, WA, USA
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