CT navigated lateral interbody fusion

Lateral interbody fusion techniques are heavily reliant on fluoroscopy for retractor docking and graft placement, which expose both the patient and surgeon to high doses of radiation. Use of image-guided technologies with CT-based images, however, can eliminate this radiation exposure for the surgeon. We describe the surgical technique of performing lateral lumbar interbody fusion using CT navigation.     

Comparison of extreme lateral approach with posterior approach in the treatment of lumbar degenerative diseases: A meta-analysis of clinical and imaging findings

ObjectiveTo compare clinical and imaging findings between extreme lateral lumbar interbody fusion (XLIF) and posterior fusion (PF) via meta-analysis for the treatment of lumbar degenerative diseases.MethodsEnglish papers reporting clinical and imaging findings for the treatment of lumbar degenerative diseases with XLIF and PF published electronically in the PubMed, Embase, Cochrane Library, and Web of Science databases from January 2006 to August 2019 were retrieved. Two authors independently extracted data and evaluated the quality of the included literature. Meta-analysis of outcome measures was performed using Stata 14 and RevMan 5.3 software.ResultsThis meta-analysis included 744 patients from nine studies, two of which were prospective studies, while the others were retrospective studies. The quality of each study was determined to be high. The meta-analysis showed no significant differences in the operative time, length of hospital stay, clinical effectiveness, and improvement in postoperative global sagittal alignment between two approaches (P > 0.05). However, XLIF was significantly better than PF in reducing intraoperative blood loss and recovery of local sagittal alignment (P < 0.05). Moreover, the high incidence of postoperative complications were detected in XLIF group (P < 0.05).ConclusionsBoth surgical approaches have equally promising clinical effectiveness for the treatment of lumbar degenerative diseases. Although XLIF can reduce intraoperative blood loss and obtain better postoperative local sagittal alignment than PF, the high incidence of postoperative complications should prompt us to consider why XLIF procedure is still being offered to our patients and how we can reduce these complications. In addition, any conclusions should be taken with caution because of the mix of prospective and retrospective studies, and the high heterogeneity and bias.     

Lateral lumbar interbody fusion in adult spine deformity – A review of literature

IntroductionSurgery for adult spine deformity presents a challenging issue for spinal surgeons with high morbidity rates reported in the literature. The minimally invasive lateral approach aims at reducing these complications while maintaining similar outcomes as associated with open spinal surgeries. The aim of this paper is to review the literature on the use of lateral lumbar interbody fusion in the cases of adult spinal deformity.MethodsA literature review was done using the healthcare database Advanced Research on NICE and NHS website using Medline. Search terms were “XLIF” or “LLIF” or “DLIF” or “lateral lumbar interbody fusion” or “minimal invasive lateral fusion” and “adult spinal deformity” or “spinal deformity”.ResultsA total of 417 studies were considered for the review and 44 studies were shortlisted after going through the selection criteria. The data of 1722 patients and 4057 fusion levels were analysed for this review. The mean age of the patients was 65.18 years with L4/5 being the most common level fused in this review. We found significant improvement in the radiological parameters (lordosis, scoliosis, and disk height) in the pooled data. Transient neurological symptoms and cage subsidence were the two most common complications reported.ConclusionLLIF is a safe and effective approach in managing adult spinal deformity with low morbidity and acceptable complication rates. It can be used alone for lower grades of deformity and as an adjuvant procedure to decrease the magnitude of open surgeries in high-grade deformities.     

极外侧椎间融合术治疗腰椎退行性疾病的近期疗效

目的:探讨极外侧椎间融合术(extreme lateral interboy fusion, XLIF)治疗腰椎退行性疾患的应用价值。方法:回顾性分析40例应用单节段XLIF治疗的腰椎退行性疾病的病例资料,观察视觉模拟疼痛评分(visual analogue scale, VAS)和Oswestry功能障碍指数(Oswestry disability index, ODI)的改善情况,摄腰椎片并评估内植物及椎间融合情况。结果:40例患者中,手术时间为35～65min,平均45.5±16.7min;术中出血量30～100m L,平均63.7±35.2m L;术后住院日3～7天,平均4.5±2.1天;所有患者术后VAS和ODI评分均显著降低,并发症发生率为20.0%,且在随访过程中均得到不同程度缓解或消失。结论:XLIF作为一种微创脊柱融合技术,可获得良好的短期疗效,具有临床应用价值,但其中远期的随访结果有待进一步观察。     

解剖型纳米羟基磷灰石/聚酰胺66椎间融合器在腰椎XLIF/OLIF手术中的三维有限元分析

目的　建立L3~5有效的三维有限元模型,研究解剖型纳米羟基磷灰石/聚酰胺66椎间融合器在XLIF/OLIF手术中的生物力学属性。 方法　建立正常人L3~5有限元模型,模拟XLIF/OLIF手术过程分别装配子弹头cage和新型解剖型cage,并对模型进行赋值得到最终有限元模型。对模型施加400 N 的轴向压缩及8 Nm 力矩的预载荷,使模型产生前屈、后伸、侧弯、旋转运动,分析两种cage的最大应力值和应力分布情况,以及两组L4-L5椎体活动度。 结果　在6种不同工况下,子弹头cage的最大应力值分别为134.83、79.17、71.31、114.96、76.85、78.77 MPa,解剖型cage最大应力值分别为56.91、61.78、35.82、52.28、31.76、32.45 MPa,解剖型cage比子弹头cage的应力分布要小且分散;两组L4-L5椎体活动度均明显小于正常人活动度,且解剖型cage组活动度要小于子弹头cage组。 结论　在腰椎XLIF/OLIF微创手术中应用新型解剖型纳米羟基磷灰石/聚酰胺66椎间融合器可以降低最大应力值,避免应力集中,减少椎体活动度,具有较好的生物力学性能。     

O-Arm-based image guidance in minimally invasive spine surgery: Technical note

Three-dimensional (3D) image guidance technology is gaining popularity in spine surgery. The O-Arm navigation platform, which relies on cone-beam CT images acquired in the operative position, represents the most recent advancement in this field. We report our technique for MIS pedicle screw insertion using the O-Arm system and present two illustrative cases. We used percutaneous technique for short construct cases and “transfascial” technique for long-construct cases. O-Arm based navigation in minimally invasive spine surgery is safe and feasible. This technology may improve surgical accuracy and clinical outcomes but long term prospective studies are needed to validate this.