title: Outcomes of Two Different Techniques Using the Lateral Approach for Lumbar Interbody Arthrodesis.
abstract: Study Design Retrospective cohort study. Objective To determine the short-term outcomes of two different lateral approaches to the lumbar spine. Methods This was a retrospective review performed with four fellowship-trained spine surgeons from a single institution. Two different approach techniques were identified. (1) Traditional transpsoas (TP) approach: dissection was performed through the psoas performed using neuromonitored sequential dilation. (2) Direct visualization (DV) approach: retractors are placed superficial to the psoas followed by directly visualized dissection through psoas. Outcome measures included radiographic fusion and adverse event (AE) rate. Results In all, 120 patients were identified, 79 women and 41 men. Average age was 64.2 years (22 to 86). When looking at all medical and surgical AEs, 31 patients (25.8%) had one or more AEs; 22 patients (18.3%) had a total of 24 neurologically related AEs; 15 patients (12.5%) had anterior/lateral thigh dysesthesias; 6 patients (5.0%) had radiculopathic pain; and 3 patients (2.5%) had postoperative weakness. Specifically, for neurologic AEs, the DV group had a rate of 28.0% and the TP group had a rate of 14.2% (p < 0.18). When looking at the rate of neurologic AEs in patients undergoing single-level fusions only, the DV group rate was 28.6% versus 10.2% for the TP group (p < 0.03). Conclusion Overall, 18.3% of patients sustained a postoperative neurologic AE following lateral interbody fusions. The TP approach had a statistically lower rate of neurologic-specific AE for single-level fusions.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Briseño
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arrigo
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Navpreet
authors.initials: N
authors.lastname: Bains
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Shashank
authors.initials: S
authors.lastname: Ravi
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, California, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tran
keywords: DLIF; XLIF; adverse events; lateral interbody; transpsoas approach