Outcomes following minimally invasive lateral transpsoas interbody fusion for degenerative low grade lumbar spondylolisthesis: A systematic review
Introduction
Spondylolisthesis, defined as the displacement of a vertebral body relative to the segment below, is an important pathology in the aging adult lumbar spine that can present as axial low back pain, radiculopathy or neurogenic claudication [1]. Surgical intervention is warranted in cases of refractory symptoms or when conservative management has failed [[2], [3], [4], [5]]. Traditional surgical treatment options have ranged from decompression alone or decompression with fusion (anterior or posterior) with or without listhesis correction to multilevel fusion for deformity correction [6,7]. Within the last decade, the advent of modern minimally invasive surgery (MIS) techniques has shortened operative times while minimizing blood loss, soft tissue dissection, muscle damage as well as postoperative incisional pain [33]. Compared to patients with degenerative disc disease, adjacent segment disease and post-laminectomy syndrome, patients with degenerative spondylolisthesis have been reported to have greater improvements in disability after lumbar fusion [23,34].
A variety of MIS arthrodesis techniques have been described, including anterior, posterior or transforaminal lumbar interbody fusion. Minimally invasive lateral lumbar interbody fusion (LLIF), also known as extreme lateral interbody fusion (XLIF, NuVasive) or direct lateral interbody fusion (DLIF, Medtronic, Memphis, TN, USA), was first described by McAfee in 1998 [8]. The procedure employs a minimally invasive retroperitoneal transpsoas approach to the lumbar spine using a tubular retractor system under real time electrophysiologic monitoring to avoid injury to the nerves of the lumbar plexus.(REF) Compared to conventional techniques, it avoids various approach-related morbidities such as vascular complications, bowel injury associated with an anterior approach and injury to the dura and nerve roots with posterior approaches [18]. Furthermore, it allows preservation of posterior bony elements and back muscles thus sparing spinal stability. It also allows the placement of a larger interbody cage thereby raising disc height and achieving indirect decompression of the neural foramen [35].
To the best of our knowledge, no review has analyzed the clinical, perioperative and radiological outcomes of LLIF for the treatment of spondylolisthesis. The aim of our study is to conduct a systematic review of available literature to evaluate the aforementioned outcomes in patients with low grade spondylolisthesis.
Section snippets
Literature search
This study adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines [9]. A comprehensive search of several databases from each database’s inception to February 1st, 2017, any language was conducted. The databases included Ovid MEDLINE Epub Ahead of Print, Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The
Search results
Our literature search yielded 143 studies of which 100 unique abstracts were assessed. After review of 21 full-text articles, a total of 8 studies were included in the qualitative and quantitative analysis [[24], [25], [26], [27], [28], [29], [30],37,38] (Fig. 1). Table 1 summarizes study characteristics. Seven studies were single-institution (three retrospective, four prospective cohorts) and one study was a multi-institution randomized controlled trial comparing lateral with transforaminal
Discussion
Minimally invasive transpsoas approach to the spine is being increasingly used to treat degenerative spine disease and spinal deformities. While an increasing amount of data on the clinical and radiological outcomes of this technique are now available, this is the first review to analyze these outcomes with respect to low grade lumbar spondylolisthesis.
In the present review, we found that all studies included uniformly reported no permanent neurologic deficits resulting from the procedure.
Conclusion
In this review, we analyzed current literature on lateral transpsoas interbody fusion for low grade lumbar spondylolisthesis. Overall, we found favorable patient reported and radiologic outcomes at final follow-up. Neurologic complication rates secondary to lumbar plexus injury, including thigh numbness, pain and hip flexion weakness, were very low and transient in nature. Future research should focus on prospective studies in order to provide further insight into the findings of this study.
Disclosures
The authors have no conflicts of interest of funding sources to disclose.
Acknowledgments
N/A
References (34)
- et al.
Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry disability index and MOS short form-36 outcomes
Spine J.
(2008) - et al.
Constipation after thoraco-lumbar fusion surgery
Clin. Neurol. Neurosurg.
(2014) - et al.
Lumbar fusion outcomes stratified by specific diagnostic indication
Spine J.
(2009) - et al.
Spondylolysis and spondylolisthesis: prevalence of different forms of instability and clinical implications
Spine
(2011) - et al.
Surgery versus conservative management in adult isthmic spondylolisthesis—a prospective randomized study: part 1
Spine
(2000) - et al.
A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration
Eur. Spine J.
(2009) - et al.
Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis
N. Engl. J. Med.
(2007) - et al.
Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993
Spine
(1994) - et al.
Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis
Eur. Spine J.
(2005) - et al.
Minimally invasive anterior retroperitoneal approach to the lumbar spine. emphasis on the lateral BAK
Spine
(1998)
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
PLoS Med.
Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the meyerding classification
Br. J. Radiol.
A comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion: a literature review and meta-analysis
BMC Musculoskelet. Disord.
Factors influencing segmental lumbar lordosis after lateral transpsoas interbody fusion
Orthop. Surg.
Sagittal alignment after lumbar interbody fusion: comparing anterior, lateral, and transforaminal approaches
J. Spinal Disord. Tech.
Radiological and clinical outcomes following extreme lateral interbody fusion
J. Neurosurg. Spine
Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report
J. Spinal Disord. Tech
Cited by (31)
Prone Transpsoas Lateral Interbody Fusion (PTP LIF) with Anterior Docking: Preliminary functional and radiographic outcomes
2023, North American Spine Society JournalComparison of PLIF/TLIF and LLIF for two-level degenerative lumbar spondylolisthesis
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementHidden blood loss in extreme lateral interbody fusion for adult spinal deformity
2023, Journal of Orthopaedic ScienceCitation Excerpt :Extreme lateral interbody fusion (XLIF) is considered to be less invasive than other surgical options because it involves the placement of a large intervertebral cage while minimizing soft tissue damage and intraoperative blood loss [1].
Sequential MRI Changes After Lateral Lumbar Interbody Fusion in Spondylolisthesis with Mild and Severe Lumbar Spinal Stenosis
2021, World NeurosurgeryCitation Excerpt :In the present study, indirect neural decompression and good clinical outcomes were achieved after LIF and PPS fixation without any major complications even for patients with severe lumbar spinal stenosis. Direct neural decompression has the potential risk of direct neural injury, incidental durotomy, epidural hematoma, deep wound infection, perineural fibrosis, and postlaminectomy instability.18,19 The advantages of LIF compared with conventional posterior procedures include restoration of disc height and indirect neural decompression.
Single-Position Prone Lateral Interbody Fusion Improves Segmental Lordosis in Lumbar Spondylolisthesis
2021, World NeurosurgeryCitation Excerpt :The lateral transpsoas approach for lumbar interbody fusion continues to gain popularity as a minimally invasive treatment strategy to achieve arthrodesis in the lumbar spine. This procedure has been shown to be well tolerated with good clinical and radiographic outcomes.1-3 Additionally, it results in less tissue disruption, blood loss, and postoperative pain compared with open surgical approaches.4