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Endoscope-Assisted Extreme-Lateral Interbody Fusion: Preliminary Experience and Technical Note


Schonauer, Claudio; Stienen, Martin Nikolaus; Gautschi, Oliver Pascal; Schaller, Karl; Tessitore, Enrico (2017). Endoscope-Assisted Extreme-Lateral Interbody Fusion: Preliminary Experience and Technical Note. World Neurosurgery, 103(Juli):869-875.e3.

Abstract

BACKGROUND The extreme lateral lumbar interbody fusion (XLIF) technique is safe and effective; however, the deep and tight surgical corridor makes visual identification of important landmark structures, as well as sufficient endplate and contralateral preparation, challenging. In the present study, we analyzed the safety and feasibility of endoscope-assisted (EA) XLIF procedures.
METHODS This was a retrospective single-center study on consecutive patients undergoing XLIF procedures between February 2014 and July 2016. EA-XLIF and conventional XLIF (c-XLIF) procedures were compared in terms of the duration of surgery, estimated blood loss (EBL), perioperative and postoperative complications, and postoperative outcomes.
RESULTS A total of 41 patients (mean age, 66.7 years ± 10.0 years; 22 males [53.7%]) underwent a XLIF procedure, including 6 (14.6%) who underwent EA-XLIF. EA-XLIF did not increase the duration of surgery or EBL. No perioperative or postoperative complications were observed in any of the EA-XLIF procedures. Clinical and radiologic outcomes at 6 weeks postsurgery and at the last follow-up (mean, 8.0 ± 5.8 months postsurgery) were similar for patients in the EA-XLIF and c-XLIF groups. The EA-XLIF technique was considered particularly helpful for checking the lumbar plexus anatomy on the psoas surface, identifying the relationship between the peritoneum and the psoas muscle, positioning the shim into the disc space, removing the disk, and checking the quality of contralateral release and endplate preparation.
CONCLUSIONS The EA-XLIF technique is safe and may be considered as an adjunct procedure, offering improved visualization to guide the surgeon in key steps of the XLIF procedure.

Abstract

BACKGROUND The extreme lateral lumbar interbody fusion (XLIF) technique is safe and effective; however, the deep and tight surgical corridor makes visual identification of important landmark structures, as well as sufficient endplate and contralateral preparation, challenging. In the present study, we analyzed the safety and feasibility of endoscope-assisted (EA) XLIF procedures.
METHODS This was a retrospective single-center study on consecutive patients undergoing XLIF procedures between February 2014 and July 2016. EA-XLIF and conventional XLIF (c-XLIF) procedures were compared in terms of the duration of surgery, estimated blood loss (EBL), perioperative and postoperative complications, and postoperative outcomes.
RESULTS A total of 41 patients (mean age, 66.7 years ± 10.0 years; 22 males [53.7%]) underwent a XLIF procedure, including 6 (14.6%) who underwent EA-XLIF. EA-XLIF did not increase the duration of surgery or EBL. No perioperative or postoperative complications were observed in any of the EA-XLIF procedures. Clinical and radiologic outcomes at 6 weeks postsurgery and at the last follow-up (mean, 8.0 ± 5.8 months postsurgery) were similar for patients in the EA-XLIF and c-XLIF groups. The EA-XLIF technique was considered particularly helpful for checking the lumbar plexus anatomy on the psoas surface, identifying the relationship between the peritoneum and the psoas muscle, positioning the shim into the disc space, removing the disk, and checking the quality of contralateral release and endplate preparation.
CONCLUSIONS The EA-XLIF technique is safe and may be considered as an adjunct procedure, offering improved visualization to guide the surgeon in key steps of the XLIF procedure.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Augmented vision, Complication, Endoscope, Endoscope assistance, Extreme lateral interbody fusion, Lateral approach, Outcome, Psoas muscle, Spine surgery, Thigh symptoms
Language:English
Date:26 April 2017
Deposited On:03 Jul 2017 09:24
Last Modified:03 Jul 2017 09:29
Publisher:Elsevier
ISSN:1878-8750
Publisher DOI:https://doi.org/10.1016/j.wneu.2017.04.110
PubMed ID:28456736

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