Lateral transpsoas fusion: indications and outcomes

Abstract

Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

Figure 1

(a) Preoperative X-rays demonstrating nonunion at L1-2 after posterior instrumented fusion and decompression from L1-S1. (b) Postoperative X-rays demonstrating XLIF at L1-2.

Figure 2

Two incision technique for a lateral transpsoas approach. (a) Surgeon's Finger traversing paraspinal muscle incision site, (b) finger identifying the retroperitoneal space, (c) surgeon's finger guiding the first dilator onto the psoas major, and (d) dilator in place traversing the psoas major directly over the intended intervertebral disc space (image reprinted with permission from Nuvasive Inc., San Diego, CA).