Results: Direct Lateral Transpsoas Approach
The average age of this patient group was 64.6 years (range 39 to 83 years). Hospital stay and estimated blood loss were increased in cases requiring posterolateral fusion with instrumentation versus percutaneous posterior tension band (PPTB), anterior stand-alone (SA) or anterior instrumentation (AI) cases (Table 2). Anterior column support was accomplished with multiple interbody devices including cylindrical metal and bone or tapered PEEK with rh-BMP 2. Complications, adverse events that altered discharge plan or patient function, occurred in 10/38 patients (Table 3). No intra-abdominal visceral injuries, dural tears, complaints of retrograde ejaculation or infection occurred in this series.
Table 2: Series Operative & Hospital Stay Data
Procedure: DLIF with |
Levels
|
EBL
|
OR Time
|
HS
|
Anterior Instrumentation |
1.3
|
137.5
|
141.2
|
3.3
|
Stand Alone |
1.1
|
49.4
|
91.9
|
2.1
|
PPTB |
1.6
|
136.2
|
207.8
|
3.4
|
PSF |
2
|
336.8
|
255.7
|
7.3
|
DLIF = direct lateral interbody fusion
EBL = estimated blood loss
HS = hospital stay
OR = operating room
PPTB = percutaneous posterior tension band
PSF = posterior spinal fusion
Table 3: Complications
Patient
|
Age
|
Sex
|
Interspace
|
Procedure Type | Implant Shape | Complication | Type |
DC
|
57
|
f
|
L2-3
|
Anterior Instrumentation | Bullet | Myocardial infarction | Medical |
MR
|
80
|
m
|
L2-3
|
Stand Alone | Cylinder | Dementia | Medical |
DR
|
53
|
m
|
L2-4
|
Anterior Instrumentation | Bullet | Psoas spasm | Approach |
ES
|
72
|
f
|
L2-4
|
Anterior Instrumentation | Bullet | Meralgia paresthetica | Approach |
RS
|
70
|
f
|
L2-4
|
PPI | Bone Dowel | Broken cable | Implant |
IY
|
77
|
f
|
L2-5
|
OPI | Bullet | Meralgia paresthetica | Approach |
JS
|
70
|
f
|
L3-4
|
Stand Alone | Cylinder | Loss of fixation | Implant |
DW
|
71
|
m
|
L3-5
|
PPI | Cylinder | Ileus/urinary retention | Medical |
CD
|
39
|
f
|
L4-5
|
PPI | Cylinder | Rt. L5 NR injury | Approach |
CA
|
62
|
f
|
L4-5
|
PPI | Cylinder | Meralgia paresthetica | Approach |
Complications: 10/38 Patients 26.3%
OPI = open posterior instrumentation
PPI = percutaneous posterior instrumentation