Results: Direct Lateral Transpsoas Approach

Written by Reginald Q. Knight, MD, MHA

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