Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation
Background: Lateral lumbar interbody fusion (LLIF) is a minimally invasive fusion procedure that may be performed with or without supplemental instrumentation. However, there is a paucity of evidence on the effect of supplemental instrumentation technique on perioperative morbidity and fusion rate i...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548422000798 |
| _version_ | 1828090170136592384 |
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| author | Sarah Nuss Owen P. Leary Bryan Zheng Spencer C. Darveau Adriel Barrios-Anderson Tianyi Niu Ziya L. Gokaslan Prakash Sampath Albert E. Telfeian Adetokunbo A. Oyelese Jared S. Fridley |
| author_facet | Sarah Nuss Owen P. Leary Bryan Zheng Spencer C. Darveau Adriel Barrios-Anderson Tianyi Niu Ziya L. Gokaslan Prakash Sampath Albert E. Telfeian Adetokunbo A. Oyelese Jared S. Fridley |
| author_sort | Sarah Nuss |
| collection | DOAJ |
| description | Background: Lateral lumbar interbody fusion (LLIF) is a minimally invasive fusion procedure that may be performed with or without supplemental instrumentation. However, there is a paucity of evidence on the effect of supplemental instrumentation technique on perioperative morbidity and fusion rate in LLIF. Methods: A single-institutional retrospective review of patients who underwent LLIF for lumbar spondylosis was conducted. Patients were grouped according to supplemental instrumentation technique: stand-alone LLIF, LLIF with laterally placed instrumentation, or LLIF with posterior percutaneous pedicle screw fixation (PPSF). Outcomes included fusion rates, peri-operative complication, and reoperation; estimated blood loss (EBL); surgery duration; length of stay; and length of follow-up. Results: 82 patients underwent LLIF at 114 levels. 35 patients (42.7%) received supplemental lateral instrumentation, 30 (36.6%) received supplemental PPSF, and 17 (20.7%) underwent stand-alone LLIF. More patients in the lateral instrumentation group had prior lumbar fusion at adjacent levels (23/35, 65.71%) versus stand-alone (3/17, 17.6%) or PPSF (2/30, 6.67%) groups (p = 0.003). 4/17 patients (23.5%) with stand-alone LLIF and 4/35 patients (11.42%) with lateral instrumentation underwent reoperation, versus 0/30 with PPSF (p = 0.030). There was no difference in fusion rates between groups (p = 0.717). Operation duration was longer in patients with PPSF (p < 0.005) and length of follow-up was longer for PPSF than lateral instrumentation (p = 0.001). Choice of instrumentation group was a statistically significant predictor of reoperation. Conclusions: While rates of complete radiographic fusion on imaging follow-up didn't differ, patients receiving PPSF were less likely than stand-alone or lateral instrumentation groups to require reoperation, though operative time was significantly longer. Further study of choice of supplemental instrumentation with LLIF is indicated. |
| first_indexed | 2024-04-11T05:52:51Z |
| format | Article |
| id | doaj.art-16a26816f9384d839527acf05c608d9f |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-11T05:52:51Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-16a26816f9384d839527acf05c608d9f2022-12-22T04:41:59ZengElsevierNorth American Spine Society Journal2666-54842022-12-0112100176Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixationSarah Nuss0Owen P. Leary1Bryan Zheng2Spencer C. Darveau3Adriel Barrios-Anderson4Tianyi Niu5Ziya L. Gokaslan6Prakash Sampath7Albert E. Telfeian8Adetokunbo A. Oyelese9Jared S. Fridley10Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Corresponding author at: Dept. of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, APC 6, 593 Eddy St, Providence, RI 02903.; Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02906Background: Lateral lumbar interbody fusion (LLIF) is a minimally invasive fusion procedure that may be performed with or without supplemental instrumentation. However, there is a paucity of evidence on the effect of supplemental instrumentation technique on perioperative morbidity and fusion rate in LLIF. Methods: A single-institutional retrospective review of patients who underwent LLIF for lumbar spondylosis was conducted. Patients were grouped according to supplemental instrumentation technique: stand-alone LLIF, LLIF with laterally placed instrumentation, or LLIF with posterior percutaneous pedicle screw fixation (PPSF). Outcomes included fusion rates, peri-operative complication, and reoperation; estimated blood loss (EBL); surgery duration; length of stay; and length of follow-up. Results: 82 patients underwent LLIF at 114 levels. 35 patients (42.7%) received supplemental lateral instrumentation, 30 (36.6%) received supplemental PPSF, and 17 (20.7%) underwent stand-alone LLIF. More patients in the lateral instrumentation group had prior lumbar fusion at adjacent levels (23/35, 65.71%) versus stand-alone (3/17, 17.6%) or PPSF (2/30, 6.67%) groups (p = 0.003). 4/17 patients (23.5%) with stand-alone LLIF and 4/35 patients (11.42%) with lateral instrumentation underwent reoperation, versus 0/30 with PPSF (p = 0.030). There was no difference in fusion rates between groups (p = 0.717). Operation duration was longer in patients with PPSF (p < 0.005) and length of follow-up was longer for PPSF than lateral instrumentation (p = 0.001). Choice of instrumentation group was a statistically significant predictor of reoperation. Conclusions: While rates of complete radiographic fusion on imaging follow-up didn't differ, patients receiving PPSF were less likely than stand-alone or lateral instrumentation groups to require reoperation, though operative time was significantly longer. Further study of choice of supplemental instrumentation with LLIF is indicated.http://www.sciencedirect.com/science/article/pii/S2666548422000798Lumbar SpineLateral lumbar interbody fusionLLIFMinimally invasive spine surgerySpinal instrumentation |
| spellingShingle | Sarah Nuss Owen P. Leary Bryan Zheng Spencer C. Darveau Adriel Barrios-Anderson Tianyi Niu Ziya L. Gokaslan Prakash Sampath Albert E. Telfeian Adetokunbo A. Oyelese Jared S. Fridley Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation North American Spine Society Journal Lumbar Spine Lateral lumbar interbody fusion LLIF Minimally invasive spine surgery Spinal instrumentation |
| title | Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation |
| title_full | Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation |
| title_fullStr | Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation |
| title_full_unstemmed | Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation |
| title_short | Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation |
| title_sort | instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion llif lateral instrumentation versus posterior pedicle screw fixation |
| topic | Lumbar Spine Lateral lumbar interbody fusion LLIF Minimally invasive spine surgery Spinal instrumentation |
| url | http://www.sciencedirect.com/science/article/pii/S2666548422000798 |
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