Major complications in extreme lateral interbody fusion access: multicentric study by Italian S.O.L.A.S. group.

PURPOSE: The eXtreme Lateral Interbody Fusion (XLIF) approach has gained increasing importance in the last decade. This multicentric retrospective cohort study aims to assess the incidence of major complications in XLIF procedures performed by experienced surgeons and any relationship between the years of experience in XLIF procedures and the surgeon's rate of severe complications. METHODS: Nine Italian members of the Society of Lateral Access Surgery (SOLAS) have taken part in this study. Each surgeon has declared how many major complications have been observed during his surgical experience and how they were managed. A major complication was defined as an injury that required reoperation, or as a complication, whose sequelae caused functional limitations to the patient after one year postoperatively. Each surgeon was finally asked about his years of experience in spine surgery and XLIF approach. Pearson correlation test was used to evaluate the association between the surgeon's years of experience in XLIF and the rate of major complications; a p-value of last than 0.05 was considered significant. RESULTS: We observed 14 major complications in 1813 XLIF procedures, performed in 1526 patients. The major complications rate was 0.7722%. Ten complications out of fourteen needed a second surgery. Neither cardiac nor respiratory nor renal complications were observed. No significant correlation was found between the surgeon's years of experience in the XLIF procedure and the number of major complications observed. CONCLUSION: XLIF revealed a safe and reliable surgical procedure, with a very low rate of major complications, when performed by an expert spine surgeon.

Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study.

INTRODUCTION: Adult deformity combined with sagittal malalignment is a pathology that decreases patient's quality of life and that requires surgical correction to achieve clinical improvement. Spine osteotomies are usually performed to restore alignment of the spine, even if these techniques are associated with high intraoperative risks, revision rates and relevant mortality rates. Anterior column realignment (ACR) is a new technique that allows large corrections through a minimally invasive lateral approach to the spine after release of the anterior longitudinal ligament. MATERIALS AND METHODS: Preoperative and postoperative full-standing X-rays of 12 patients who underwent ACR procedure were retrospectively reviewed. Spinopelvic alignment parameters of sagittal balance were measured on standing full-spine radiographs. Any intraoperative or postoperative complication was reported, as technical notes such the number of treated levels, associated XLIFs and cases of revision surgery. RESULTS: 11 out of 12 patients had a complete data set and were enrolled in this study. The mean preoperative and postoperative lumbar lordosis values were, respectively, -20° ± 17° and -51° ± 9.8° (p < 0.001), while a mean value of 27° of lordosis were restored at a single ACR level. Two major complications occurred, a bowel perforation and a postoperative early infection of the posterior wound that required surgical debridement. CONCLUSIONS: Preliminary data show that ACR allows corrections similar to those obtained with a Pedicle Subtraction Osteotomy, avoiding risks related to this technique.

Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis.

PURPOSE: To present in a single source the relevant information needed to assess spinopelvic balance and alignment, and to estimate the amount of correction needed in a patient during surgical treatment. METHODS: Narrative literature review RESULTS: Sagittal balance can be evaluated by global balance estimates (sagittal vertical axis and T1 tilt). Other important parameters are the relationship between pelvic incidence and lumbar lordosis (spinopelvic harmony), between pelvic incidence and difference of thoracic kyphosis and lumbar lordosis (spinopelvic balance), excess of pelvic tilt, knee flexion and thoracic compensatory hypokyphosis. Different methods to calculate the amount of surgical correction needed in patients with sagittal imbalance have been based on combinations of these parameters. CONCLUSIONS: Relevant parameters of sagittal imbalance have been identified and correlated with clinical outcomes. Methods for calculation of surgical correction of imbalance have been proposed, but not validated in patients with mid-term follow-up.