title: Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity.
abstract: We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has been an increasing emphasis on minimally invasive fusion and instrumentation techniques, with the aim of minimizing surgical trauma and blood loss and reducing hospitalization. From six electronic databases, 21 eligible studies were included for review. The pooled weighted average mean of preoperative visual analogue scale (VAS) pain scores was 6.8, compared to a postoperative VAS score of 2.9 (p<0.0001). The weighted average preoperative and postoperative coronal segmental Cobb angles were 3.6 and 1.1°, respectively. The weighted average preoperative and postoperative coronal regional Cobb angles were 19.1 and 10.0°, respectively. Regional lumbar lordosis also significantly improved from 35.8 to 43.3°. Sagittal alignment was comparable pre- and postoperatively (34 mm versus 35.1mm). The weighted average operative duration was 125.6 minutes, whilst the mean estimated blood loss was 155 mL. The weighted average hospitalization length was 3.6 days. Whilst the available data is limited, minimally invasive XLIF procedures appear to be a promising alternative for the treatment of scoliosis, with improved functional VAS and Oswestry disability index outcomes and restored coronal deformity. Future comparative studies are warranted to assess the long term benefits and risks of XLIF compared to anterior and posterior procedures.
authors.affiliation: NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia; Westmead Hospital, Westmead, Sydney, NSW, Australia.
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
authors.affiliation: Westmead Hospital, Westmead, Sydney, NSW, Australia.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Scherman
authors.affiliation: Westmead Hospital, Westmead, Sydney, NSW, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Dandie
authors.affiliation: NeuroSpine Clinic, Prince of Wales Private Hospital, Level 7, Barker Street, Randwick, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia. Electronic address: ralphmobbs@hotmail.com.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D005260:Female; D006801:Humans; D008141:Lordosis / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: Direct lateral interbody fusion; Lateral lumbar interbody fusion; Minimally invasive; Spinal deformity