94 - Lumbar XLIF and Bilateral Percutaneous Pedicle Screw Fixation Performe...

#94 Lumbar XLIF and Bilateral Percutaneous Pedicle Screw Fixation Performed all in Lateral Position

Lumbar Therapies and Outcomes

Poster Presented by: J. Buric

Author(s):

J. Buric (1)
D. Bombardieri (1)
C. Del Gaizo (1)

(1) CDC Villa Torri, Spine Surgery, Bologna, Italy

Abstract

Objective: Evaluation of the feasibility, technical difficulty and clinical results in performing combined lumbar XLIF and bilateral percutaneous pedicle screw fixation done all in lateral position.

Background: Lumbar XLIF and bilateral percutaneous pedicle fixation is a valuable minimally invasive approach for achieving an useful and solid lumbar circumferential fusion in selected cases. Currently, a change in the position of the patient on the operating table from lateral to prone is used. Theoretically, being able to perform both approaches in the same position, would significantly reduce surgical time.

Materials and Methods: Fifteen consecutive patients were submitted to a circumferential fusion done in the same, lateral, position. There were 9 female and 6 male patients, mean age 52 years. Low back pain due to degenerative disc disease were the prevalent symptom and pathology, respectively. Follow-up was recorded for operation time and walk out of bed timing and compared to the group of patients operated previously in whom the change in position was used. Clinical outcome was evaluated with VAS and ODI scores.

Results: Seven patients performed a two-level circumferential fusion, fife at L3-L5 levels and two at L1-L3 levels while 8 patients performed the procedure on a single level (six on L4-L5 and two on L3-L4). Mean surgical time was 79 (±14) minutes (29 for XLIF and 50 for pedicle fixation) for one level and 114 (±21) minutes (54 for XLIF and 60 for pedicle fixation) for more than one level surgery. Average time lap between the XLIF part and pedicle screw part of the procedure was 6 (±2) minutes. As compared to the usual approach with the change in position, approximately 20 minutes were saved. There was no significant difference in walk out of bed timing as well as no difference was found for clinical outcome scores (VAS and ODI). No differences in screw positioning were found on post-op X-rays between the two groups as well as no additional complications were noted in this group of patients as compared to the patients operated previously with the change in position.

Conclusions: Lumbar circumferential fusion with XLIF and bilateral percutaneous pedicle screw fixation performed in lateral position seems a useful modification of the standard procedure done in two different positions. The main advantage is time saving. Technical challenge in performing the procedure in lateral position is slightly more demanding due to different patient orientation however, the learning curve is short and after a few cases the timing of the approaches between prone and lateral position equals. No differences in clinical and radiological outcomes and complication rates were noted.