In Brief Study Design. Retrospective chart review of prospectively collected data from 2 nonrandomized, nonconcurrent cohorts. Objective. Early results of 2 lumbar interbody fusion procedures—open posterior lumbar interbody fusion (PLIF) and minimally invasive (extreme lateral interbody fusion [XLIF])—were compared in octogenarians to demonstrate the safety of each in the extreme elderly populations. Summary of Background Data. Although spinal pathologies are common in the elderly patients, additional health conditions often preclude operative treatment because anesthesia, blood loss, and recovery are too demanding. Minimally invasive approaches reduce procedure-related morbidity and recovery time. Methods. In our single-site prospective series of XLIF patients, 40 were identified as those aged ≥80 years with a minimum of 3-month follow-up. A complete, retrospective review of surgical patients treated in the same practice with traditional open posterior (PLIF) approach found 20 patients aged ≥80 years. Comparisons were made between groups to identify differences in morbidity and mortality rates. Results. No clinically significant differences in demographics, diagnoses, or comorbidities were found between groups. Complication rate, blood loss/transfusion rate, and hospital stay were significantly lower in the minimally invasive surgery (MIS) group (P < 0.0001). MIS patients left the hospital an average of 4 days earlier than the open PLIF patients, most discharged home (92.5% XLIF vs. 0% PLIF) rather than to skilled nursing facilities. Six deaths occurred in the PLIF follow-up, 3 within 3 months postoperatively; there was 1 death at 6 months postoperatively XLIF. Conclusion. Surgical treatment need not be withheld on the basis of age; elderly patients can successfully be treated using MIS techniques, and are—in our experience—among the most satisfied with their outcomes, enjoying significant improvements in pain, mobility, and quality of life. A retrospective chart review of prospectively collected outcomes after lumbar interbody fusion surgery in patients aged ≥80 years in 2 nonconcurrent surgical cohorts shows that minimally invasive surgery (extreme lateral interbody fusion approach) results in fewer complications, quicker recovery, and improved quality of life compared with a traditional open (posterior lumbar interbody fusion) procedure.
A retrospective review of prospective data of all patients undergoing extreme lateral interbody fusion (XLIF) for degenerative disease of the lumbar and thoracic spine.To compare between obese and nonobese patients, the incidence of early complications and predictive factors affecting complication rate.XLIF is a 90-degree off midline approach that allows for large graft placement, excellent disk height restoration, and indirect decompression at the stenotic motion segment. As the psoas muscle is traversed, the lumbosacral plexus is protected by the use of automated electrophysiology through dynamic discrete evoked electromyogram thresholding. Exposure is achieved with an expandable split-blade retractor, which allows for direct illuminated visualization facilitating discectomy and complete anterior column stabilization by using a large load-bearing implant that rests on the dense ring apophysis bilaterally.A retrospective chart review of a prospectively compiled database of all patients treated with the XLIF procedure between October 2006 and July 2008 was completed. Early complications were defined as any adverse events occurring within the first 3 months of the index procedure. The National Institute of Health Guidelines for defining obesity relating to body mass index were used.Out of 432 patients, 313 have complete data: 156 obese, 157 nonobese. The ages, comorbidities, earlier surgeries, and diagnoses were equivalent. There were no transfusions and no infections. Complications were minimal and about the same in each group.Unlike traditional open lumbar fusion procedures, minimally invasive surgery (XLIF) has no greater risk of complication in the obese patient.
Clinical and Radiographic Outcome in Less Invasive Lumbar Fusion: XLIF at Two Year Follow-Up
Much has been written recently in the medical and lay press about the relative benefits of less invasive therapeutic interventions. Despite the widespread acceptance of less invasive treatments in general surgery and orthopaedics as evidenced by the routine application of endoscopic gastrointestinal procedures and arthroscopic surgery of the joints, spine surgeons have, in general, been slower to adopt less invasive approaches to the treatment of spinal maladies.
