Checklist Aims to Improve Flow, Reduce Risks During Minimally Invasive Lateral Interbody Fusion (MIS-LIF)

Juan S. Uribe, MD and Paul D. Kim, MD Comment

Peer Reviewed

Researchers from the University of South Florida have developed a systematic approach to preoperative assessment and surgical technique an intraoperative neuromonitoring for use during retroperitoneal minimally invasive lateral interbody fusion (MIS-LIF).

“The main objective of the checklist is to reduce the risk for complications and improve patient outcomes,” said coauthor Juan S. Uribe, MD, Associate Professor of Neurosurgery and Director of the Spine Section at the University of South Florida, Tampa.

surgeon doctor holding a checklist“The main objective of the checklist is to reduce the risk for complications and improve patient outcomes”“MIS-LIF is not complex compared to other spine surgeries, but has so many moving parts and technical nuances that it requires a systematic approach for outcomes to be reproducible and predictable,” Dr. Uribe told SpineUniverse. “If you start taking short cuts or don’t follow steps in order every time, your outcomes can be compromised.”

Checklist Helps Guide Efficient Retraction of Lumbar Plexus
In particular, proper manipulation of the lumbar plexus is critical to this approach as injury to this area is the most common surgical complications, Dr. Uribe explained.

“If you don’t control the direction and duration of the retraction of the lumbar plexus injury can result,” Dr. Uribe said. “When you use the checklist, there is better flow to the procedure and you can retract the lumbar plexus more efficiently.”

Patient positioning is a key aspect of the checklist (see Table). The authors note that generally the patient is positioned on the side of their body without prior surgery and/or the side with more favorable psoas and lumbar plexus anatomy facing up. For patients with scolosis, the patient is positioned with the concave side facing up.

checklist for patient positioning during MIS-LIFThe checklist is based on the authors’ 10 years of experience performing MIS-LIF, and was developed in collaboration with members of the Society of Lateral Access Surgery (SOLAS).

Checklist Helps Surgeons Navigate the Surgical Corridor
“This checklist helps surgeons safely navigate the surgical corridor while performing a MIS-LIF,” commented Paul D. Kim, MD, who is an orthopaedic spine surgeon at the Spine Institute of San Diego.

“All of the items on the checklist are valuable, particularly when navigating the psoas corridor,” Dr. Kim told SpineUniverse. “Due to the close proximity of the nerves in the psoas musculature, there are a number of potential risks while transversing the psoas muscle and docking on the lateral spinal column. Thus, it is crucial that the surgeon be provided with real-time information on the position of instruments in relation to the surrounding nerves during this approach.”

“Surgeons should utilize this checklist to help identify neural compromise and minimize detectable neural damage,” Dr. Kim added. In addition, the checklist is essential for physicians beginning their careers in spine surgery to follow when performing lateral procedures as it covers all safety precautions, Dr. Kim said. He added that “real-time discrete-threshold responses are highly valuable and adherence to advanced neuromonitoring remain key to a satisfactory outcome.”

Updated on: 03/20/18
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Surgical Approach Is a Risk Factor for Infection in Spinal Surgery
Juan S. Uribe, MD, FAANS
Professor of Neurosurgery
Barrow Neurological Institute
Phoenix, AZ
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