Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience
Study DesignTechnical report.ObjectiveEvaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique.Summary of Background DataWith the development of surgical techniques, the indications for oblique lumbar...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.995662/full |
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| author | Junjie Xu Junjie Xu Enliang Chen Le Wang Xiaobao Zou Chenfu Deng Chenfu Deng Junlin Chen Junlin Chen Rencai Ma Rencai Ma Xiangyang Ma Zenghui Wu Zenghui Wu |
| author_facet | Junjie Xu Junjie Xu Enliang Chen Le Wang Xiaobao Zou Chenfu Deng Chenfu Deng Junlin Chen Junlin Chen Rencai Ma Rencai Ma Xiangyang Ma Zenghui Wu Zenghui Wu |
| author_sort | Junjie Xu |
| collection | DOAJ |
| description | Study DesignTechnical report.ObjectiveEvaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique.Summary of Background DataWith the development of surgical techniques, the indications for oblique lumbar interbody fusion (OLIF) surgery have been broadened to the L5/S1 segment. However, this technique also has limitations. Different from OLIF, the L5/S1 segment used to be considered the main contraindication for XLIF. To date, no authors have reported the application of XLIF at the L5/S1 level.MethodsOnly patients whose preoperative lumbar MRI showed the position of the psoas major muscles and blood vessels at the L5/S1 level were similar to those seen at supra-L5 levels were seleted. By folding the operating table, the iliac crest was moved downward to expose the L5/S1 intervertebral space during the operation. The remaining surgical procedures were consistent with routine XLIF surgery.Results8 patients successfully underwent XLIF at the L5/S1 level. The L5/S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The post operative radiographs showed a satisfactory L5/S1 reconstruction with good cage position. Only 1 patient (12.5%) felt thigh numbness, and the symptoms gradually resolved after surgery and were no longer present in a month. There were no cases of psoas hematoma, retrograde ejaculation or vascular injury. The postoperative VAS score showed that all the patients achieved satisfactory results.ConclusionsXLIF at L5-S1 is feasible in strictly selected cases after thorough preoperative preparation and careful intraoperative procedures. However, we did not recommend XLIF as a routine surgical option at the L5/S1 level. |
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| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-12T20:10:34Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Surgery |
| spelling | doaj.art-bdd48fd3099243e58ef2bf7108a890a22022-12-22T03:18:15ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-09-01910.3389/fsurg.2022.995662995662Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experienceJunjie Xu0Junjie Xu1Enliang Chen2Le Wang3Xiaobao Zou4Chenfu Deng5Chenfu Deng6Junlin Chen7Junlin Chen8Rencai Ma9Rencai Ma10Xiangyang Ma11Zenghui Wu12Zenghui Wu13The First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaDepartment of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, ChinaDepartment of Orthopedics, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaThe First School of Clinical Medicine, Southern Medical University, Guangzhou, ChinaDepartment of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou, ChinaStudy DesignTechnical report.ObjectiveEvaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique.Summary of Background DataWith the development of surgical techniques, the indications for oblique lumbar interbody fusion (OLIF) surgery have been broadened to the L5/S1 segment. However, this technique also has limitations. Different from OLIF, the L5/S1 segment used to be considered the main contraindication for XLIF. To date, no authors have reported the application of XLIF at the L5/S1 level.MethodsOnly patients whose preoperative lumbar MRI showed the position of the psoas major muscles and blood vessels at the L5/S1 level were similar to those seen at supra-L5 levels were seleted. By folding the operating table, the iliac crest was moved downward to expose the L5/S1 intervertebral space during the operation. The remaining surgical procedures were consistent with routine XLIF surgery.Results8 patients successfully underwent XLIF at the L5/S1 level. The L5/S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The post operative radiographs showed a satisfactory L5/S1 reconstruction with good cage position. Only 1 patient (12.5%) felt thigh numbness, and the symptoms gradually resolved after surgery and were no longer present in a month. There were no cases of psoas hematoma, retrograde ejaculation or vascular injury. The postoperative VAS score showed that all the patients achieved satisfactory results.ConclusionsXLIF at L5-S1 is feasible in strictly selected cases after thorough preoperative preparation and careful intraoperative procedures. However, we did not recommend XLIF as a routine surgical option at the L5/S1 level.https://www.frontiersin.org/articles/10.3389/fsurg.2022.995662/fullXLIFL5-S1iliac crestiliac vesselslumbar plexussurgical technique |
| spellingShingle | Junjie Xu Junjie Xu Enliang Chen Le Wang Xiaobao Zou Chenfu Deng Chenfu Deng Junlin Chen Junlin Chen Rencai Ma Rencai Ma Xiangyang Ma Zenghui Wu Zenghui Wu Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience Frontiers in Surgery XLIF L5-S1 iliac crest iliac vessels lumbar plexus surgical technique |
| title | Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience |
| title_full | Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience |
| title_fullStr | Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience |
| title_full_unstemmed | Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience |
| title_short | Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience |
| title_sort | extreme lateral interbody fusion xlif approach for l5 s1 preliminary experience |
| topic | XLIF L5-S1 iliac crest iliac vessels lumbar plexus surgical technique |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.995662/full |
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