Skip to main content
SpringerLink
Log in

Substantial clinical benefit of minimally invasive lateral interbody fusion for degenerative spondylolisthesis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Conventional lumbar arthrodesis for the treatment of degenerative spondylolisthesis (DS) is associated with high complication rates and variable clinical efficacy. Modern minimally invasive (MIS) approaches may reduce the morbidity and produce greater clinical improvement compared to traditional surgical techniques. The objective of this study is to report radiographic outcomes and evaluate clinical improvements in the context of substantial clinical benefit for DS patients treated with a MIS 90° lateral, transpsoas approach for lumbar interbody fusion.

Methods

From 2005 to 2011, 60 consecutive patients were treated with MIS lateral interbody fusion for Grade I or II DS at a single institution. Mean patient age was 68 years, 75 % were female, and 30 % had undergone previous lumbar surgery. A total of 71 levels were treated, supplemental posterior fixation was used in 57 (95 %) cases, and 26 (43 %) patients underwent additional direct posterior decompression.

Results

Average follow-up was 20.3 months. Average ORT, EBL, and LOS were 206 min, 83 cc, and 1.29 days, respectively. Complications occurred in 3 (5 %) patients. Transient approach-related thigh/groin pain was observed in 5 (8 %) cases. There were no cases of pseudoarthrosis. At 1 year, LBP improved 71 %, LP improved 68 %, ODI decreased 52 %, and SF-36 PCS and MCS improved 43 and 21 %, respectively. Substantial clinical benefit was met by 94.7 % of patients on NRS LBP, by 84.6 % on NRS LP, by 83.7 % on ODI, and by 66.7 % on SF-36 PCS. Disc height increased 71 % and segmental lordosis increased 27.8 % at treated levels. Foraminal height, width, and volume increased 19.7, 18.0, and 39.6 %, respectively. Slip improved 60.7 % with interbody fusion only and further improved to 69.2 % after the placement of supplemental instrumentation.

Conclusions

MIS lateral interbody fusion in the treatment of DS resulted in significant improvements in clinical and radiographic outcomes, with a low complication rate and a high proportion of patients achieving substantial clinical benefit.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 6:1295–1304

    Article  Google Scholar 

  2. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 22:2257–2270

    Article  Google Scholar 

  3. Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY (2008) Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 9:1839–1847

    Article  Google Scholar 

  4. 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 4:435–443

    Article  Google Scholar 

  5. Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine 1:26–32

    Article  Google Scholar 

  6. 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 26(Suppl):S331–S337

    Article  Google Scholar 

  7. Cappuccino A, Cornwall GB, Turner AW, Fogel GR, Duong HT, Kim KD, Brodke DS (2010) Biomechanical analysis and review of lateral lumbar fusion constructs. Spine 26(Suppl):S361–S367

    Article  Google Scholar 

  8. Elowitz EH, Yanni DS, Chwajol M, Starke RM, Perin NI (2011) Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg 5–6:201–206

    Google Scholar 

  9. Rodgers WB, Lehmen JA, Gerber EJ, Rodgers JA (2012) Grade 2 spondylolisthesis at L4–5 treated by XLIF: safety and midterm results in the “worst case scenario”. Sci World J 2012:356712

    Article  CAS  Google Scholar 

  10. Rodgers WB, Cox CS, Gerber EJ (2010) Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech 6:393–397

    Article  Google Scholar 

  11. Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L (2012) Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis. Sci World J 2012:456346

    Article  Google Scholar 

  12. Ogilvie JW (2005) Complications in spondylolisthesis surgery. Spine 6(Suppl):S97–101

    Article  Google Scholar 

  13. Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L (2006) Clinical and radiologic 2-4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine 15:1693–1698

    Article  Google Scholar 

  14. Park Y, Ha JW, Lee YT, Oh HC, Yoo JH, Kim HB (2011) Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of spondylolisthesis and degenerative segmental instability. Asian Spine J 4:228–236

    Article  Google Scholar 

  15. Meyerding HW (1956) Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 26(5 Part 1):566–591

    CAS  PubMed  Google Scholar 

  16. Matsunaga S, Sakou T, Morizono Y, Masuda A, Demirtas AM (1990) Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage. Spine 11:1204–1210

    Article  Google Scholar 

  17. Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine 16:1791–1798

    Article  Google Scholar 

  18. Luk KD, Chow DH, Holmes A (2003) Vertical instability in spondylolisthesis: a traction radiographic assessment technique and the principle of management. Spine 8:819–827

    Google Scholar 

  19. Glassman SD, Carreon LY, Djurasovic M, Dimar JR, Johnson JR, Puno RM, Campbell MJ (2009) Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J 1:13–21

    Article  Google Scholar 

  20. Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine 24:2764–2770

    Article  Google Scholar 

  21. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 6:968–974

    Article  Google Scholar 

  22. Shamji MF, Isaacs RE (2008) Anterior-only approaches to scoliosis. Neurosurgery 3(Suppl):139–148

    Article  Google Scholar 

  23. Ferrara LA, Secor JL, Jin BH, Wakefield A, Inceoglu S, Benzel EC (2003) A biomechanical comparison of facet screw fixation and pedicle screw fixation: effects of short-term and long-term repetitive cycling. Spine 12:1226–1234

    Google Scholar 

  24. Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery. Part 2: histologic and histochemical analyses in humans. Spine 22:2598–2602

    Article  Google Scholar 

  25. Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery. Part 1: histologic and histochemical analyses in rats. Spine 22:2590–2597

    Article  Google Scholar 

  26. Kim CW (2010) Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine 26(Suppl):S281–S286

    Article  Google Scholar 

  27. Kim CW, Siemionow K, Anderson DG, Phillips FM (2011) The current state of minimally invasive spine surgery. Instr Course Lect 60:353–370

    PubMed  Google Scholar 

  28. Kim DY, Lee SH, Chung SK, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine 1:123–129

    Article  CAS  Google Scholar 

  29. Hukins DW, Kirby MC, Sikoryn TA, Aspden RM, Cox AJ (1990) Comparison of structure, mechanical properties, and functions of lumbar spinal ligaments. Spine 8:787–795

    Google Scholar 

  30. Baker JK, Reardon PR, Reardon MJ, Heggeness MH (1993) Vascular injury in anterior lumbar surgery. Spine 15:2227–2230

    Article  Google Scholar 

  31. Flynn JC, Price CT (1984) Sexual complications of anterior fusion of the lumbar spine. Spine 5:489–492

    Article  Google Scholar 

  32. Christensen FB, Bunger CE (1997) Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. Int Orthop 3:176–180

    Article  Google Scholar 

  33. Brau SA (2002) Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications. Spine J 3:216–223

    Article  Google Scholar 

  34. Penta M, Fraser RD (1997) Anterior lumbar interbody fusion. A minimum 10-year follow-up. Spine 20:2429–2434

    Article  Google Scholar 

  35. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 1(Suppl):60–64

    Google Scholar 

  36. Scaduto AA, Gamradt SC, Yu WD, Huang J, Delamarter RB, Wang JC (2003) Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. J Spinal Disord Tech 6:502–507

    Article  Google Scholar 

  37. Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 2:92–97

    Article  Google Scholar 

  38. Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M (2006) Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 4:304–309

    Article  PubMed  Google Scholar 

  39. Rihn JA, Patel R, Makda J, Hong J, Anderson DG, Vaccaro AR, Hilibrand AS, Albert TJ (2009) Complications associated with single-level transforaminal lumbar interbody fusion. Spine J 8:623–629

    Article  Google Scholar 

  40. Tohmeh AG, Rodgers WB, Peterson MD (2011) Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine 1:31–37

    Article  Google Scholar 

  41. Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 3:E7

    Article  Google Scholar 

  42. Uribe JS, Vale FL, Dakwar E (2010) Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine 26(Suppl):S368–S374

    Article  Google Scholar 

  43. Epstein NE (2008) How often is minimally invasive minimally effective: what are the complication rates for minimally invasive surgery? Surg Neurol 4:386–388

    Article  Google Scholar 

  44. McAfee PC, Phillips FM, Andersson G, Buvenenadran A, Kim CW, Lauryssen C, Isaacs RE, Youssef JA, Brodke DS, Cappuccino A, Akbarnia BA, Mundis GM, Smith WD, Uribe JS, Garfin S, Allen RT, Rodgers WB, Pimenta L, Taylor W (2010) Minimally invasive spine surgery. Spine 26(Suppl):S271–S273

    Article  Google Scholar 

  45. Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 2:210–219

    Article  Google Scholar 

  46. Berjano P, Lamartina C (2011) Minimally invasive lateral transpsoas approach with advanced neurophysiologic monitoring for lumbar interbody fusion. Eur Spine J 9:1584–1586

    Article  Google Scholar 

  47. Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21:S37–S42

    Article  PubMed  Google Scholar 

  48. Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22:S242–S253

    Article  PubMed  Google Scholar 

  49. Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 4:557–562

    Article  CAS  Google Scholar 

  50. Pumberger M, Hughes AP, Huang RR, Sama AA, Cammisa FP, Girardi FP (2012) Neurologic deficit following lateral lumbar interbody fusion. Eur Spine J 6:1192–1199

    Article  Google Scholar 

Download references

Conflict of interest

Dr. Khajavi is a consultant for NuVasive, Inc. and has received research grants from NuVasive, Inc., though none were received related to this work. Alessandria Shen, subsequent to this work, became employed directly by NuVasive for a short time and no longer has any conflicts. No other authors report any conflicts.

Author information

Authors and Affiliations

  1. Georgia Spine and Neurosurgery Center, 2001 Peachtree Rd Suite 550, Atlanta, GA, USA

    Kaveh Khajavi, Alessandria Shen & Anthony Hutchison

  2. The Institute for Neurosurgical and Spinal Research (INSPIRE) Foundation, Atlanta, GA, USA

    Kaveh Khajavi, Alessandria Shen & Anthony Hutchison

Authors
  1. Kaveh Khajavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandria Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony Hutchison
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaveh Khajavi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khajavi, K., Shen, A. & Hutchison, A. Substantial clinical benefit of minimally invasive lateral interbody fusion for degenerative spondylolisthesis. Eur Spine J 24 (Suppl 3), 314–321 (2015). https://doi.org/10.1007/s00586-015-3841-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-3841-1

Keywords

Search

Navigation