Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Spine and Adult Deformity: Surgical Technique and the Evidence

Abstract

The use of Lateral Lumbar Interbody Fusion (LLIF) initially applied for degenerative lumbar conditions, was expanded to the treatment of degenerative scoliosis as first reported by Phillips and Pimenta in 20051. Since then LLIF has been increasingly applied in the treatment of complex sagittal and coronal plane deformities. This approach can be performed “stand-alone” or in conjunction with posterior open or percutaneous pedicle screw placement. The lateral approach avoids the vascular risks of the anterior lumbar approach and the extensive soft tissue dissection and neural manipulation during a posterior approach. LLIF has been shown to be a safe, effective and low morbidity technique for achieving interbody fusion for a variety of lumbar conditions. LLIF has been shown to facilitate the restoration of disc height, sagittal balance and indirect decompression of neural elements. Injuries to the lumbar plexus have been described with this approach and risks can be reduced with use of real time neural surveillance as well as minimizing the duration of psoas retraction.