Skip to main content

Multilevel TLIF for Spinal Deformity

  • Chapter
  • First Online:
Minimally Invasive Spinal Deformity Surgery

Abstract

Adult spinal deformity (ASD) refers to an abnormal spinal curvature in the coronal, axial, and sagittal plane in adult patients. Most ASDs are de novo degenerative deformities that are caused by asymmetric disc and facet degeneration or osteoporotic spine insufficiency fracture [20]. Recent publications have indicated that the prevalence of any radiographic evidence of ASD can be as high as 60 % in adults older than 60 years of age [19, 24] and symptomatic scoliosis is seen in 6–30 % of the elderly population. Patients with ASD most commonly seek treatment due to pain and disability from the deformity and its associated disc degeneration, spinal stenosis, nerve roots compression, lateral listhesis, spondylolisthesis, and the overall loss of spinopelvic balance. Most symptomatic ASD patients are initially treated with conservative measures such as physical therapy, nonsteroidal anti-inflammatory medication, and narcotic analgesics. When conservative treatment fails, operative procedures aiming to decompress lumbar nerve roots and the thecal sac stabilize unstable motion segments, reestablish global spinal balance in all planes, and prevent deformity progression are indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Acosta FL, Liu J, Slimack N, Moller D, Fessler R, Koski T. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. J Neurosurg Spine. 2011;15:92–6.

    Article  PubMed  Google Scholar 

  2. Akbarnia BA, Mundis GM, Jr., Moazzaz P, Kabirian N, Bagheri R, Eastlack RK, et al. Anterior Column Realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech. Available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=akbarnia%2C+mundis%2C+eastlack; Accessed 19 Feb 2013. [Epub ahead of print].

  3. Anand N, Hamilton JF, Perri B, Miraliakbar H, Goldstein T. Cantilever TLIF with structural allograft and RhBMP2 for correction and maintenance of segmental sagittal lordosis: long-term clinical, radiographic, and functional outcome. Spine (Phila Pa 1976). 2006;31:E748–53.

    Google Scholar 

  4. Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976). 1999;24:171220.

    Google Scholar 

  5. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976). 2009;34:21718.

    Google Scholar 

  6. Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA, Jr., Kim YJ, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32:224552.

    Google Scholar 

  7. Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS. Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. ScientificWorldJournal. 2012;2012:789698.

    Article  PubMed  Google Scholar 

  8. Deukmedjian AR, Le TV, Baaj AA, Dakwar E, Smith DA, Uribe JS. Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases. J Neurosurg Spine. 2012;17:530–9.

    Article  PubMed  Google Scholar 

  9. Dorward IG, Lenke LG, Bridwell KH, O’Leary PT, Stoker GE, Pahys JM, et al. Transforaminal versus anterior lumbar interbody fusion in long deformity constructs: a matched cohort analysis. Spine (Phila Pa 1976). 2013;38:E755–62.

    Google Scholar 

  10. Faundez AA, Mehbod AA, Wu C, Wu W, Ploumis A, Transfeldt EE. Position of interbody spacer in transforaminal lumbar interbody fusion: effect on 3-dimensional stability and sagittal lumbar contour. J Spinal Disord Tech. 2008;21:175–80.

    Article  PubMed  Google Scholar 

  11. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30:20249.

    Google Scholar 

  12. Godde S, Fritsch E, Dienst M, Kohn D. Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine (Phila Pa 1976). 2003;28:16939.

    Google Scholar 

  13. Hassanzadeh H, Jain A, El Dafrawy MH, Ain MC, Mesfin A, Skolasky RL, et al. Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976). 2012;38:726–31

    Google Scholar 

  14. Heary RF, Karimi RJ. Correction of lumbar coronal plane deformity using unilateral cage placement. Neurosurg Focus. 2010;28:E10.

    Article  PubMed  Google Scholar 

  15. Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine. 2007;7:379–86.

    Article  PubMed  Google Scholar 

  16. Jagannathan J, Sansur CA, Oskouian RJ, Jr., Fu KM, Shaffrey CI. Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery. 2009;64:95563; discussion 963–54.

    Google Scholar 

  17. Karikari IO, Nimjee SM, Hardin CA, Hughes BD, Hodges TR, Mehta AI, et al. Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: initial clinical experience and early outcomes. J Spinal Disord Tech. 2011;24:368–75.

    Article  PubMed  Google Scholar 

  18. Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976). 2007;32:218997.

    Google Scholar 

  19. Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N. A prospective study of de novo scoliosis in a community based cohort. Spine (Phila Pa 1976). 2006;31:17882.

    Google Scholar 

  20. Kotwal S, Pumberger M, Hughes A, Girardi F. Degenerative scoliosis: a review. HSS J. 2011;7:257–64.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Lee MJ, Wiater B, Bransford RJ, Bellabarba C, Chapman JR. Lordosis restoration after Smith-Petersen osteotomies and interbody strut placement: a radiographic study in cadavers. Spine (Phila Pa 1976). 2010;35:E1487–91.

    Google Scholar 

  22. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6:435–43.

    Article  PubMed  Google Scholar 

  23. Pateder DB, Gonzales RA, Kebaish KM, Cohen DB, Chang JY, Kostuik JP. Short-term mortality and its association with independent risk factors in adult spinal deformity surgery. Spine (Phila Pa 1976). 2008;33:12248.

    Google Scholar 

  24. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30:10825.

    Google Scholar 

  25. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35:222431.

    Google Scholar 

  26. Schwab FJ, Hawkinson N, Lafage V, Smith JS, Hart R, Mundis G, et al. Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J. 2012;21:2603–10.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Schwab FJ, Patel A, Shaffrey CI, Smith JS, Farcy JP, Boachie-Adjei O, et al. Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough? Clinical article. J Neurosurg Spine. 2012;16:539–46.

    Article  PubMed  Google Scholar 

  28. Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech. 2005;18:S1–6.

    Google Scholar 

  29. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech. 2011;24:242–50.

    Article  PubMed  Google Scholar 

  30. Shau DN, Parker SL, Mendenhall SK, Zuckerman SL, Godil SS, Devin CJ, McGirt MJ. Transforaminal lumbar interbody graft placement via an articulating delivery arm facilitates increased segmental lordosis with superior anterior and midline graft placement. J Spinal Disord Tech. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23059702; Accessed 10 Oct 2012. [Epub ahead of print].

  31. Smith JS, Sansur CA, Donaldson WF, 3rd, Perra JH, Mudiyam R, Choma TJ, et al. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2011;36:95864.

    Google Scholar 

  32. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 2009;65:8693; discussion 93–84.

    Google Scholar 

  33. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976). 2009;34:16938.

    Google Scholar 

  34. Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976). 2011;36:81724.

    Google Scholar 

  35. Stephens GC, Yoo JU, Wilbur G. Comparison of lumbar sagittal alignment produced by different operative positions. Spine (Phila Pa 1976). 1996;21:18026; discussion 1807.

    Google Scholar 

  36. Suh LR, Jo DJ, Kim SM, Lim YJ. A surgical option for multilevel anterior lumbar interbody fusion with ponte osteotomy to achieve optimal lumbar lordosis and sagittal balance. J Korean Neurosurg Soc. 2012;52:365–71.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Uribe JS, Smith DA, Dakwar E, Baaj AA, Mundis GM, Turner AW, et al. Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers. J Neurosurg Spine. 2012;17:476–85.

    Article  PubMed  Google Scholar 

  38. Wang MY. Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation. J Neurosurg Spine. 2013;18:4–12.

    Article  PubMed  Google Scholar 

  39. Wang MY, Madhavan K. Mini-open pedicle subtraction osteotomy: surgical technique. World Neurosurg. 2012.

    Google Scholar 

  40. Yson SC, Santos ER, Sembrano JN, Polly Jr DW. Segmental lumbar sagittal correction after bilateral transforaminal lumbar interbody fusion. J Neurosurg Spine. 2012;17:37–42.

    Article  PubMed  Google Scholar 

  41. Zheng X, Chaudhari R, Wu C, Mehbod AA, Erkan S, Transfeldt EE. Biomechanical evaluation of an expandable meshed bag augmented with pedicle or facet screws for percutaneous lumbar interbody fusion. Spine J. 2010;10:987–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Wien

About this chapter

Cite this chapter

Lu, Y., Falcone, M.M., Wang, M.Y., Wu, S. (2014). Multilevel TLIF for Spinal Deformity. In: Wang, M., Lu, Y., Anderson, D., Mummaneni, P. (eds) Minimally Invasive Spinal Deformity Surgery. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1407-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-1407-0_18

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1406-3

  • Online ISBN: 978-3-7091-1407-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics