This article is more than 5 years old. Information may no longer be current.
Debaters address effectiveness claims for lateral transpsoas spine fusion
The lateral transpsoas approach for fusion has enjoyed increased popularity among spine surgeons and there are claims it can help reduce operative time, blood loss, and the length of the hospital stay compared with the more traditional anterior and posterior approaches for spine fusion.
In a face-off session, Christopher L. Shaffrey, MD, FAANS, and Juan S. Uribe, MD, FAANS, discussed the benefits and claims of the new lateral transpsoas approach and if it was worth so much consideration by surgeons who perform spine surgery.
Based on an article by Vishal C. Patel, MD, the lateral transpsoas approach for spinal fusion was developed for patients who have low back pain associated with degenerative disc disease but do not have severe central canal stenosis. In the report, the technique was said to have a low complication rate and to offer patients a lot of pain reduction.
Believe the hype?
Every so often, a new spine technology or technique is introduced that gains immense popularity among surgeons and it is heralded as a technique that will “revolutionize spine surgery” and becomes widespread in use, Shaffrey said during his presentation.
Christopher L. Shaffrey
However, after it is used by many for a while, surgeons sometimes start to find that the complication rates are generally higher than advertised and its use drops in response, he said.
“Most of those technologies have a surgeon developer behind the development of it. When people make millions of dollars based on positive reports, everyone has to be a bit askance as to how accurate those results are,” Shaffrey said. “It is not to say that transpsoas is bad, but we need to have skepticism that this thing is going to go and revolutionize spine surgery and that every spine surgery should be done with this approach.”
Mastery issues
Furthermore, lateral transpsoas fusion is also a complicated procedure to master and perform, according to Shaffrey, and it can lead to complications and revisions in patients. The technique is most commonly used at the L4-5 level; about 75% of the procedures are done at this location, he said.
“I think Juan would agree that this is one of the most difficult levels to do this, and with the highest potential risk to your patient at that level. I think you need to be extremely experienced to be routinely doing L4-5 transpsoas procedures,” Shaffrey said. “You need to have the best of skill and the ability to look in there and say: this is something that is potentially dangerous in this patient.”
Difficult, but necessary
Uribe agreed with Shaffrey the procedure is complicated and should only be performed by highly skilled surgeons. But, he said the technique is so effective and provides such great health outcomes that it is worth mastering.
Juan S. Uribe
“It is a procedure that makes most sense,” Uribe said, but noted that safety in performing it is of utmost importance
“You need to be a very good technician and have to be able to control direction, amount and time of the nerve retraction to be successful,” he said.
Keys to success
The key to a successful transpsoas approach for spinal fusion, Uribe said, involves three factors and every surgeon must understand them. They are being able to master the regional neurovascular anatomy, good understanding of the electrophysiological monitoring or EMG and a meticulous surgical technique, he said.
Lateral transpsoas fusion is a great option for the correct patient and the correct surgeon, both of which need to be determined before the procedure is undertaken, according to Uribe.
“For a good clean outcome, you have to find the right candidate for the right procedure,” he said. “The point is this: You have to determine the right tool for the right procedure.” – by Robert Linnehan
References:
Patel VC. Sci World J. 2012;doi:http://dx.doi.org/10.1100/2012/893608.
Shaffrey CL, Uribe JS. Neurological Face-Off: Lateral transpsoas fusion. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.
For more information:
Christopher L. Shaffrey, MD, FAANS, can be reached at University of Virginia School of Medicine, PO Box 800212, Charlottesville, VA 22908; email: das9g@virginia.edu.
Juan S. Uribe, MD, can be reached at University of South Florida, USF 2 Tampa General Circle, Tampa, FL 33606; email: juansuribe@gmail.com.
Disclosures: Shaffrey has no relevant financial disclosures. Uribe is a paid consultant to Nuvasive Inc.
Perspective
Back to Top
John C. Liu
Complications with the procedure can be early or late. You can stand on both sides of the fence and make a very strong argument. What makes spine surgery so interesting from that perspective is there are many issues in spine that we can improve and definitely a lot of research can be done to try and help us better define how we treat patients. This would be a perfect example of that.
John C. Liu, MD
Spine Surgery Today Chief Medical Editor, Neurosurgery