Oblique lumbar interbody fusion with L5-S1 may be safe, feasible
Click Here to Manage Email Alerts
Despite greater operative complexity, inclusion of L5-S1 in oblique lumbar interbody fusion may be safe and feasible with no increase in early complications, according to published results.
Chirag A. Berry, MD, and colleagues assessed and compared demographics, levels fused, indications, operative time, estimated blood loss, vascular ligation, intraoperative blood transfusion, length of stay, discharge to rehabilitation facility and complications among 87 patients who underwent oblique lumbar interbody fusion at 167 spine levels that either did (n=19; group A) or did not (n=68; group B) include L5-S1. When included, researchers found the L5-S1 level was approached through a left-sided intrabifurcation approach, left-sided pre-psoas approach or a right-sided pre-psoas approach.
Results showed patients in group A had a significantly longer operative time vs. patients in group B. However, subanalyses for two- and three-level surgeries showed no difference in operative time between the two groups. Researchers found no statistically significant differences in estimated blood loss and length of stay between the two groups. According to results, 68.4% of patients in group A and 5.9% of patients in group B required ligation of the iliolumbar vein, segmental veins, median sacral vessels or any vascular structure, as needed for adequate exposure.
Although one patient in each group experienced minor vascular injuries, researchers found no major vascular injuries in either group. Researchers noted no significant difference in complications between groups A and B, or between the three approaches to L5-S1. Complications trended lower in the latter part of the series as the learning curve progressed, according to results.
“Oblique anterolateral approaches to the lumbar spine are minimally invasive and less morbid than other approaches. L5-S1 can be safely approached using three variations of this technique, but requires significant experience working next to large blood vessels. Access surgeons (vascular or general surgeons) usually assist with the approach,” Berry told Healio Orthopedics. “This article provides guidance to access surgeons such that they consider all possible options based on the specific patient’s vascular anatomy. These approaches are relatively new but are proven to be safe in experienced hands.”
Collapse
Read more about
Click Here to Manage Email Alerts