Direct lateral access lumbar and thoracolumbar fusion: preliminary results

Abstract

Purpose: To describe the clinical outcomes and complications in a consecutive series of extreme lateral interbody fusion cases.

Methods: Retrospective cohort review of 97 consecutive patients from three centers with minimum 6-month follow-up (mean 12 months). Functional status was evaluated by preoperative and last follow-up Oswestry Disability Index score. Leg and back pain were evaluated by visual analog scales. Complications were recorded and permanent complications and neurological impairment was actively investigated at last follow-up.

Results: No permanent neurological impairment, vascular or visceral injuries were observed. Transient neurological symptoms presented in 7% of cases, all resolved within 1 month from surgery. Transient thigh discomfort was observed in 9%. Clinical success was recorded in 92% of cases.

Conclusions: Extreme lateral interbody fusion is a safe and effective technique for anterior interbody fusion.

Fig. 1

De novo degenerative scoliosis. One level XLIF with coronal asymmetrical cage and posterior interlaminal plate fixation. Good disc height restoration and correction of segmental scoliosis at 6 months

Fig. 2

De Novo degenerative scoliosis. Selective fusion of the apex with two-level XLIF and percutaneous pedicle screws (derotation of the apex through posterior instrumentation). Fair correction of the deformity, adjacent disc mobility is preserved. Good clinical result at 6 months

Fig. 3

One level degenerative disc disease without neurological symptoms. XLIF plus bilateral percutaneous pedicle-screw fixation. One-year postoperative films show interbody fusion with preservation of lordosis with excellent clinical result

Fig. 4

L4-L5 degenerative spondylolisthesis. XLIF plus percutaneous unilateral pedicle-screw fixation. At 12 months, interbody fusion is evident with preservation of lordosis. Excellent clinical result