602 - Initial Learning Curve and Early Experience in Lateral Transpsoas Appr...

#602 Initial Learning Curve and Early Experience in Lateral Transpsoas Approach for Lumbar Interbody Fusion

MIS Techniques and Outcomes

Poster Presented by: A. Dias Carvalho

Author(s):

A. Dias Carvalho (1)
A. Carvalho Araujo (1)

(1) Serviço de Ortopedia e Traumatologia, Hospital São Marcos, Clínica Ortomed, Teresina, Piauí, Brazil

Abstract

Introduction: The lateral transpsoas approach for lumbar interbody fusion (XLIF) has been widely reported in the literature, generally by experienced surgeons. We aim to report complications, clinical, and radiographic results in the initial learning curve of XLIF procedures.

Methods: Prospective collected data from a single surgeon from May2012 to Sep2013. Preop radiographic evaluation included X-rays, CT and MRI; and for postop early, included X-rays and CT to evaluate cage positioning. Intraoperative and postop data were analyzed, as well as radiographic images, clinical outcomes and complications.

Results: It was identified 12 cases (19 lumbar levels) treated with XLIF (18mm AP diameter cages). The series included different conditions: adult degenerative scoliosis (ADS) - 4 cases; discitis - 2 cases; DDD - 2 cases; degenerative spondylolisthesis - 2 cases; recurrent lumbar disc herniation - 1 case; lumbar stenosis - 1 case. At the time of this abstract the maximum follow-up is 15 months, and minimum 2 weeks. Mean age was 63.4 (17.3 SD; range 24-83), 8 males and 4 females. One L1L2 level was treated, 3 L2L3, 6 L3L4, and 9 L4L5. 7 cases were performed as anterior only and 5 received pedicle screws. No case needed direct decompression. Operative time ranged from 50 to 160, and only 4 cases (ADS) blood loss were more than 100ml. Complications were observed: subsidence in 2 cases (discitis cases) - 1 at 3m and 1 at 15d - patients experienced improvement in back pain symptoms despite subsidence; neurologic deficits at L5/S1 right hand side nerve root (1 case due to posterior instrumentation).Neither restenosis nor motor deficits was observed. Complete fusion was observed in all cases (4 cases) with minimum 12m follow-up.

Conclusion: The XLIF approach is an unusual surgical route for many spine surgeons and may be a challenge during the early experience. But if the surgical steps are strictly respected (including neuromonitoring), it is feasible to safely treat lumbar degenerative conditions with this minimal invasive option.