Survey of major complications after prone transpsoas surgery: an analysis of early adopters' practice.

INTRODUCTION: The prone transpsoas technique (PTP) is a modification of the traditional lateral lumbar interbody fusion approach, which was first published in the literature in 2020. The technique provides several advantages, such as lordosis correction and redistribution, single-position surgery framework, and ease of performing posterior techniques when needed. However, the prone position also leads to the movement of some retroperitoneal, vascular, and neurological structures, which could impact the complication profile. Therefore, this study aimed to investigate the occurrence of major complications in the practice of early adopters of the PTP approach. METHODS: A questionnaire containing 8 questions was sent to 50 participants and events involving early adopters of the prone transpsoas technique. Of the 50 surgeons, 32 completed the questionnaire, which totaled 1963 cases of PTP surgeries. RESULTS: Nine of the 32 surgeons experienced a major complication (28%), with persistent neurological deficit being the most frequent (7/9). Of the total number of cases, the occurrence of permanent neurological deficits was approximately 0,6%, and the rate of vascular and visceral injuries were both 0,05% (1/1963 for each case). CONCLUSION: Based on the analysis of the questionnaire responses, it can be concluded that PTP is a safe technique with a very low rate of serious complications. However, future studies with a more heterogeneous group of surgeons and a more rigorous linkage between answers and patient data are needed to support the findings of this study.

Comparison of segmental lordosis gain of prone transpsoas (PTP) vs. lateral lumbar interbody fusion.

INTRODUCTION: Lumbar interbody fusion is a standard method to treat certain degenerative conditions that are refractory to conservative treatments. LLIF reduces posterior muscle damage, can relieve neurological symptoms through indirect decompression, provides increased stability with its wider cages, and promotes more significant segmental lordosis than standard posterior techniques. However, the technique possesses its issues, such as unusual positioning, possible plexus-related symptoms, and median segmental lordosis correction. Trying to ease those issues, the idea of a prone transpsoas technique occurred. METHODS: Retrospective, single-centric, comparative, and non-randomized study. The authors paired patients receiving lateral lumbar interbody fusion (LLIF) or prone transpsoas (PTP) to evaluate the technique's impact on the segmental lordosis correction. A correlation test selected the covariates for the matching. p-Values inferior to 0.05 were deemed significant. RESULTS: Seventy-one patients were included in the analysis, 53 in the LLIF group and 18 in the PTP group. The significant covariates to the segmental lordosis correction were technique, preoperative segmental lordosis, cage position, and preoperative pelvic tilt. After the paring model, PTP showed significant segmental lordosis correction potential regarding the LLIF. CONCLUSION: The prone transpsoas approach can significantly enhance the correction of segmental lordosis proportionated to the traditional LLIF approach.

Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent literature.

INTRODUCTION: The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF. MATERIAL AND METHODS: This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample. RESULTS: Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05). CONCLUSION: Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.

Minimally invasive versus open surgery for degenerative lumbar pathologies:a systematic review and meta-analysis.

INTRODUCTION: With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several treatment options are available to treat degenerative spinal diseases, such as laminectomies, posterior fusions, and interbody fusions, depending on their locations, correction necessities, and surgeon philosophy. With the advance in technology and surgical knowledge, minimally invasive techniques (MIS) arose as a solution to reduce surgical morbidity, while maintaining the same benefits as the traditionally/open surgeries. Several studies investigated the possible advantages of MIS techniques against the traditional open procedures. However, those articles are usually focused only on one technique or on one pathology. METHODS: The electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed. Only original articles in English or Portuguese were added to the review, the revision was performed following the PRISMA guideline. RESULTS: Fifty-three studies were included in the meta-analysis. Of the studied outcomes the Length of Stay Odds of complications, Blood Loss, and Surgery costs presented significantly favored MIS approaches, while the Last FUP ODI score, and Surgery Time did not differ among the groups. CONCLUSION: Minimally invasive techniques are a remarkably interesting option to traditional open surgeries, as these procedures showed a significant reduction in blood loss, hospitalization time, complications, and surgical costs.

Hérnia medular idiopática atípica ­ relato de caso / Atypical Idiopathic Spine Cord Herniation (ISCH) ­ Case Report

A hérnia medular idiopática (HMI) é uma causa rara de mielopatia progressiva que afeta principalmente mulheres de meia idade com apresentação clínica típica com a Síndrome de Brown-Sequard. Possui etiologia incerta, sendo a teoria mais aceita a de ser um defeito congênito na dura-máter que leva a uma herniação lenta e progressiva da medula que ocasiona uma lesão evolutiva, podendo levar a um déficit irreversível quando subdiagnosticado e não tratado da forma ideal. A realização da ressonância magnética é fundamental para o diagnóstico, e a cirurgia é o tratamento de escolha para reverter e cessar os sintomas mielopáticos. O presente artigo mostra um caso de uma apresentação atípica da localização do defeito dural e da herniação, não descrita ainda na literatura, levando a uma apresentação neurológica e anatômica incomum para esta patologia, obrigando a realizar um planejamento cirúrgico específico para tal caso.

Idiopathic medullary hernia is a rare cause of progressive myelopathy, primarily affecting middle-aged women, typical clinical presentation with Brown-Sequárd Syndrome. Its etiology is uncertain, but the most accepted theory is that a congenital defect in the dura mater leads to a slow and progressive spinal cord herniation, causing an evolutionary spinal cord injury, which can lead to an irreversible deficit when underdiagnosed and not treated adequately. Magnetic resonance imaging is essential for the diagnosis, and surgery is the treatment of choice to reverse and stop myelopathy symptoms. The present article shows a case of an atypical presentation of the location of the dural defect and herniation, not yet described in the literature, leading to an unusual neurologic and anatomical presentation for this pathology, requiring a specific planning for this case.

Influence of psychosocial distress in the results of elective lumbar spine surgery.

BACKGROUND: Low back pain can be caused by several pathological entities and its perception can be altered by external factors, for example by some psychological and social factors. The objective of this study was to compare surgical outcomes in patients with or without psychosocial issues. METHODS: Single center, retrospective and comparative study. Patients with indication to elective lumbar spine surgery were screened for some psychosocial factors. As a result of the screening, patients were divided in two groups: mild psychosocial issues (green group) or moderate psychosocial issues (yellow group). The groups were compared using the following variables: demographic and clinical history, depression (HAD-D), anxiety (HAD-A), pain levels [visual analogue scale (VAS)], disability [Oswestry disability index (ODI)] and quality of life [EuroQol 5D (EQ-5D)] at preop and 6-12 months follow-up. RESULTS: A total of 136 patients were included (51% female) in this study. The 62.5% were allocated at the green group, and 37.5% in the yellow group. Similar pain levels were observed at preop, but the green group evolved with superior improvement in pain levels after surgery (P=0.003). In the ODI and EQ-5D scales, the green group had already shown lower clinical disability at preop (P=0.009 and P=0.003, respectively) and evolved with better outcomes at the final evaluation (P=0.049 and P=0.017). VAS, ODI and EQ-5D scores improved from baseline similarly in both groups. CONCLUSIONS: Presurgical screening identify the presence of psychological distress. Psychosocial factors are correlated with poorer clinical outcomes, both in the baseline and after the surgery. Despite the differences between found, even patients with mild psychosocial impairment can experience clinical improvement with surgery.