Abstract
Purpose
Lateral access lumbar interbody fusion (LLIF) is a minimally invasive technique that has an increasing popularity. It offers unique advantages and circumvents risk of certain serious complications encountered in other conventional spinal approaches. This study provides a statistical analysis defining the lateral access learning curve in the Asian population.
Methods
This prospective study included 32 consecutive patients who underwent LLIF from April 2012 to August 2014. The surgeries were performed by two senior spine surgeons and follow-up was conducted at 6 weeks, 3, 6, 9 months and 1 year post-operation.
Results
The breakpoint in operating time occurred at the 22nd level operated, from a mean of 71 min in the early phase group to a mean of 42 min in the steady state group. LLIF at L4/5 level is technically more demanding but technically feasible as competency is achieved.
Conclusions
During the learning process, there was no compromise of perioperative or clinical outcomes. It should be feasibly incorporated into a spine surgeon’s repertoire of procedures for the lumbar spine.
Similar content being viewed by others
References
Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA (2011) Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 24(4):242–250. doi:10.1097/BSD.0b013e3181ecf995
Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine 35(26 Suppl):S331–S337. doi:10.1097/BRS.0b013e3182022db0
Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28(3):E8. doi:10.3171/2010.1.focus09282
Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6(4):435–443. doi:10.1016/j.spinee.2005.08.012
Rodgers WB, Gerber EJ, Rodgers JA (2010) Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine 35(26 Suppl):S355–S360. doi:10.1097/BRS.0b013e3182023796
Berjano P, Lamartina C (2011) Minimally invasive lateral transpsoas approach with advanced neurophysiologic monitoring for lumbar interbody fusion. Eur Spine J 20(9):1584–1586. doi:10.1007/s00586-011-1997-x
Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22(2):242–253. doi:10.1007/s00586-012-2426-5
Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L (2011) Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years follow-up. J Neurosurg Spine 14(1):38–45. doi:10.3171/2010.9.spine09865
Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21(Suppl 1):S37–S42. doi:10.1007/s00586-012-2217-z
Arnold PM, Anderson KK, McGuire RA Jr (2012) The lateral transpsoas approach to the lumbar and thoracic spine: a review. Surg Neurol Int 3(Suppl 3):S198–S215. doi:10.4103/2152-7806.98583
Formica M, Berjano P, Cavagnaro L, Zanirato A, Piazzolla A, Formica C (2014) Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23(Suppl 6):684–692. doi:10.1007/s00586-014-3545-y
Khajavi K, Shen AY (2014) Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J 23(6):1215–1223. doi:10.1007/s00586-014-3246-6
Aichmair A, Lykissas MG, Girardi FP, Sama AA, Lebl DR, Taher F, Cammisa FP, Hughes AP (2013) An institutional six-year trend analysis of the neurological outcome after lateral lumbar interbody fusion: a 6-year trend analysis of a single institution. Spine 38(23):E1483–E1490. doi:10.1097/BRS.0b013e3182a3d1b4
Hyde J, Seits M (2011) Clinical experience, outcomes, and learning curve following XLIF for lumbar degenerative conditions. WScJ 2(1):21–26
Meredith DS, Kepler CK, Huang RC, Hegde VV (2013) Extreme lateral interbody fusion (XLIF) in the thoracic and thoracolumbar spine: technical report and early outcomes. Musculoskeletal J of HSS J 9(1):25–31. doi:10.1007/s11420-012-9312-x
Lee KH, Yeo W, Soeharno H, Yue WM (2014) Learning curve of a complex surgical technique: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). J Spinal Disord Tech. doi:10.1097/bsd.0000000000000089
Muggeo VM (2003) Estimating regression models with unknown break-points. Stat Med 22(19):3055–3071. doi:10.1002/sim.1545
Obenchain TG (1991) Laparoscopic lumbar discectomy: case report. J Laparoendosc Surg 1(3):145–149
Franke J, Greiner-Perth R, Boehm H, Mahlfeld K, Grasshoff H, Allam Y, Awiszus F (2009) Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial. Eur Spine J 18(7):992–1000. doi:10.1007/s00586-009-0964-2
Park DK, Lee MJ, Lin EL, Singh K, An HS, Phillips FM (2010) The relationship of intrapsoas nerves during a transpsoas approach to the lumbar spine: anatomic study. J Spinal Disord Tech 23(4):223–228. doi:10.1097/BSD.0b013e3181a9d540
Benglis DM, Vanni S, Levi AD (2009) An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. J Neurosurg Spine 10(2):139–144. doi:10.3171/2008.10.spi08479
Uribe JS, Vale FL, Dakwar E (2010) Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine 35(26 Suppl):S368–S374. doi:10.1097/BRS.0b013e3182027976
Uribe JS, Arredondo N, Dakwar E, Vale FL (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13(2):260–266. doi:10.3171/2010.3.spine09766
Singer G (2005) Occupational radiation exposure to the surgeon. J Am Acad Orthop Sur 13(1):69–76
Pumberger M, Hughes AP, Huang RR, Sama AA, Cammisa FP, Girardi FP (2012) Neurologic deficit following lateral lumbar interbody fusion. Eur Spine J 21(6):1192–1199. doi:10.1007/s00586-011-2087-9
Acknowledgments
We would like to acknowledge Richard Tjahjono, medical illustrator, for his drawings used in this article.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ng, C.L.L., Pang, B.C., Medina, P.J.A. et al. The learning curve of lateral access lumbar interbody fusion in an Asian population: a prospective study. Eur Spine J 24 (Suppl 3), 361–368 (2015). https://doi.org/10.1007/s00586-015-3876-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-3876-3