Transpsoas Lateral Lumbar Interbody Fusion Research Articles

Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion.

The LLIF procedure is a useful stand-alone and adjunct surgical approach for many spinal conditions. One complication of LLIF is subsidence of the interbody graft into the vertebral bodies, resulting in severe pain, impaired arthrodesis and potentially fracture of the body. Low bone density, as measured by T score on DEXA scanning, has also been postulated to increase the risk of subsidence. A retrospective review of prospectively collected data was performed on all patients who underwent LLIF at this institution consisting of 712 levels in 335 patients. Patients with subsidence following LLIF were recorded. We utilized the T score obtained from the femoral neck DEXA scans, which is used to determine overall fracture risk. The T score of patients with subsidence was compared to those without subsidence. 20 of 57 (35 %) patients without subsidence had a DEXA T score between -1.0 and -2.4 consistent osteopenia, one patient (1.8 %) exhibited a T score less than -2.5, consistent with osteoporosis. 13 patients of 23 (57 %) with subsidence exhibited a T score between -1.0 and -2.4, consistent with osteopenia, five (22 %) exhibited a T score of -2.5 or less, consistent with osteoporosis. The mean DEXA T score in patients with subsidence was -1.65 (SD 1.04) compared to -0.45 (SD 0.97) in patients without subsidence (p < 0.01). The area under the receiver operating characteristic curve for patients with a T score of -1.0 or less was 80.1 %. Patients with DEXA T scores less than -1.0 who undergo stand-alone LLIF are at a much higher risk of developing graft subsidence. Further, they are at an increased risk of requiring additional surgery. In patients with poor bone quality, consideration could be made to supplement the LLIF cage with posterior instrumentation.

Incidence of Lumbar Plexopathy while Utilizing Mechanomyography (MMG) as an Alternative to Electromyography (EMG) for Transpsoas Lateral Lumbar Interbody Fusion (LLIF)

Incidence of Lumbar Plexopathy while Utilizing Mechanomyography (MMG) as an Alternative to Electromyography (EMG) for Transpsoas Lateral Lumbar Interbody Fusion (LLIF)

The morphometric study of l3-L4 and L4-L5 lumbar spine in Asian population using magnetic resonance imaging: feasibility analysis for transpsoas lumbar interbody fusion.

Cross-sectional study on the measurement of relevant magnetic resonance imaging parameters in 100 patients presented for lumbar spine assessment. To determine anatomical position of lumbar plexus and major blood vessels in relation to vertebral body and anterior edge of psoas muscle at L3-L4 and L4-L5 and to define the safe working zone for transpsoas approach for lumbar fusion. Lateral transpsoas lumbar interbody fusion has been shown to be safe and provides alternative for lumbar fusion. However, proximity of neurovascular structures may not allow a safe passage for this procedure in the Asian population. Relevant parameters were measured from axial magnetic resonance images and analyzed, including the psoas muscle and vertebrae endplate diameters, lumbar plexus and psoas muscle distance, lumbar plexus and vertebra body distance, and vena cava to the anterior vertebrae body diameters. The mean anteroposterior diameters of the right and left psoas muscle ranged from 44.0 to 58.6 mm and 44.8 to 54.0 mm, respectively. The mean anteroposterior diameters of vertebra endplate of L3, L4, and L5 were 38.2 mm, 39.3 mm, and 41.4 mm, respectively. The mean distance of posterior border of vena cava from the vertebra body was 4.5 mm at L3-L4 and 14.1 mm at L4-L5. L3-L4 fusion is feasible at both sides in both sexes; however, at L4-L5 level, the procedure is feasible only on the left side. The safe working zone for transpsoas approach to lumbar spine is significantly narrower at L4-L5 in both sexes. Anterior edge of psoas muscle can be used as a reliable guide to locate lumbar plexus within psoas muscle. N/A.

Lateral lumbar interbody fusion

Since its inception in the year 2001 the minimally invasive trans-psoas Lateral Lumbar Interbody Fusion (LLIF) approach has gained significant favor among spine surgeons. It is now routinely utilized to treat an array of spinal pathologies including degenerative disc disease, low grade spondylolisthesis, and adult spinal deformity. The intent of this video is to provide a step by step account of the basic procedural details when performing the LLIF procedure for a single level broad based degenerated lumbar disc with herniation. The video can be found here: http://youtu.be/dZFMqmCz6Q8.