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L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study

INTRODUCTION: Potential advantages of the Extreme Lateral Interbody Fusion (XLIF) approach are smaller incisions, preserving anterior and posterior longitudinal ligaments, lower blood loss, shorter operative time, avoiding vascular and visceral complications, and shorter length of stay. We hypothesi...

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Autores principales: Quack, Valentin, Eschweiler, Jörg, Prechtel, Christina, Migliorini, Filippo, Betsch, Marcel, Maffulli, Nicola, Gutteck, Natalia, Tingart, Markus, Kobbe, Philipp, Pishnamaz, Miguel, Hildebrand, Frank, Arbab, Dariusch
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652979/
https://www.ncbi.nlm.nih.gov/pubmed/36369101
http://dx.doi.org/10.1186/s13018-022-03320-0
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author Quack, Valentin
Eschweiler, Jörg
Prechtel, Christina
Migliorini, Filippo
Betsch, Marcel
Maffulli, Nicola
Gutteck, Natalia
Tingart, Markus
Kobbe, Philipp
Pishnamaz, Miguel
Hildebrand, Frank
Arbab, Dariusch
author_facet Quack, Valentin
Eschweiler, Jörg
Prechtel, Christina
Migliorini, Filippo
Betsch, Marcel
Maffulli, Nicola
Gutteck, Natalia
Tingart, Markus
Kobbe, Philipp
Pishnamaz, Miguel
Hildebrand, Frank
Arbab, Dariusch
author_sort Quack, Valentin
collection PubMed
description INTRODUCTION: Potential advantages of the Extreme Lateral Interbody Fusion (XLIF) approach are smaller incisions, preserving anterior and posterior longitudinal ligaments, lower blood loss, shorter operative time, avoiding vascular and visceral complications, and shorter length of stay. We hypothesize that not every patient can be safely treated at the L4/5 level using the XLIF approach. The objective of this study was to radiographically (CT-scan) evaluate the accessibility of the L4/5 level using a lateral approach, considering defined safe working zones and taking into account the anatomy of the superior iliac crest. METHODS: Hundred CT examinations of 34 female and 66 male patients were retrospectively evaluated. Disc height, lower vertebral endplate (sagittal and transversal), and psoas muscle diameter were quantified. Accessibility to intervertebral space L4/5 was investigated by simulating instrumentation in the transverse and sagittal planes using defined safe zones. RESULTS: The endplate L5 in the frontal plane considering defined safe zones in the sagittal and transverse plane (Zone IV) could be reached in 85 patients from the right and in 83 from the left side. Through psoas split, the safe zone could be reached through psoas zone II in 82 patients from the right and 91 patients from the left side. Access through psoas zone III could be performed in 28 patients from the right and 32 patients from the left side. Safe access and sufficient instrumentation of L4/5 through an extreme lateral approach could be performed in 76 patients of patients from the right and 70 patients from the left side. CONCLUSION: XLIF is not possible and safe in every patient at the L4/5 level. The angle of access for instrumentation, access of the intervertebral disc space, and accessibility of the safe zone should be taken into account. Preoperative imaging planning is important to identify patients who are not suitable for this procedure.
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spelling pubmed-96529792022-11-15 L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study Quack, Valentin Eschweiler, Jörg Prechtel, Christina Migliorini, Filippo Betsch, Marcel Maffulli, Nicola Gutteck, Natalia Tingart, Markus Kobbe, Philipp Pishnamaz, Miguel Hildebrand, Frank Arbab, Dariusch J Orthop Surg Res Research Article INTRODUCTION: Potential advantages of the Extreme Lateral Interbody Fusion (XLIF) approach are smaller incisions, preserving anterior and posterior longitudinal ligaments, lower blood loss, shorter operative time, avoiding vascular and visceral complications, and shorter length of stay. We hypothesize that not every patient can be safely treated at the L4/5 level using the XLIF approach. The objective of this study was to radiographically (CT-scan) evaluate the accessibility of the L4/5 level using a lateral approach, considering defined safe working zones and taking into account the anatomy of the superior iliac crest. METHODS: Hundred CT examinations of 34 female and 66 male patients were retrospectively evaluated. Disc height, lower vertebral endplate (sagittal and transversal), and psoas muscle diameter were quantified. Accessibility to intervertebral space L4/5 was investigated by simulating instrumentation in the transverse and sagittal planes using defined safe zones. RESULTS: The endplate L5 in the frontal plane considering defined safe zones in the sagittal and transverse plane (Zone IV) could be reached in 85 patients from the right and in 83 from the left side. Through psoas split, the safe zone could be reached through psoas zone II in 82 patients from the right and 91 patients from the left side. Access through psoas zone III could be performed in 28 patients from the right and 32 patients from the left side. Safe access and sufficient instrumentation of L4/5 through an extreme lateral approach could be performed in 76 patients of patients from the right and 70 patients from the left side. CONCLUSION: XLIF is not possible and safe in every patient at the L4/5 level. The angle of access for instrumentation, access of the intervertebral disc space, and accessibility of the safe zone should be taken into account. Preoperative imaging planning is important to identify patients who are not suitable for this procedure. BioMed Central 2022-11-11 /pmc/articles/PMC9652979/ /pubmed/36369101 http://dx.doi.org/10.1186/s13018-022-03320-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Quack, Valentin
Eschweiler, Jörg
Prechtel, Christina
Migliorini, Filippo
Betsch, Marcel
Maffulli, Nicola
Gutteck, Natalia
Tingart, Markus
Kobbe, Philipp
Pishnamaz, Miguel
Hildebrand, Frank
Arbab, Dariusch
L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title_full L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title_fullStr L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title_full_unstemmed L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title_short L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study
title_sort l4/5 accessibility for extreme lateral interbody fusion (xlif): a radiological study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652979/
https://www.ncbi.nlm.nih.gov/pubmed/36369101
http://dx.doi.org/10.1186/s13018-022-03320-0
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