ABSTRACT
PURPOSE: The purpose of this study is to evaluate the feasibility and the safety of a new skin incision for minimally invasive anterior lumbar interbody fusion (ALIF): the perinavel incision. METHODS: Demographic and clinical data from patients who underwent ALIF with the perinavel incision were collected. Indications to surgery, preoperative symptoms, radiological data, number of treated levels, intraoperative and early postoperative complications and wound-related problems were analysed. RESULT: Ninety-seven patients underwent ALIF with this new skin incision. One hundred fifty-seven levels were treated (mean 1.7 level per patient) being L4-L5 the most frequently treated. Intraoperative complications were represented only by the venous injury with a rate of 3.09% (3 cases). Postoperative complications were all linked to skin incision issues: a case of wound dehiscence and a case of superficial infection. No case of skin necrosis occurs at 3-month follow-up. CONCLUSIONS: In this paper, the perinavel skin incision was demonstrated to be as safe as traditional approaches for ALIF. Furthermore, with this incision it is possible to perform multilevel (L3-S1) ALIF, which means a good option in minimally invasive surgery as well as revision surgery. These slides can be retrieved under Electronic Supplementary Material.
Subject(s)
Lumbar Vertebrae/surgery , Spinal Diseases/surgery , Spinal Fusion/methods , Adult , Aged , Feasibility Studies , Female , Humans , Intraoperative Complications/etiology , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/etiology , Retrospective Studies , Spinal Fusion/adverse effects , Vascular System Injuries/etiologyABSTRACT
INTRODUCTION: Sagittal imbalance is an important risk factor for spinal disability, pain and loss of health related quality of life. Its correction has a positive impact on these outcomes. Still, it is a very aggressive surgery, with a high revision rate. The aim of this study is to analyze the most important causes of failure of surgery for correction of sagittal imbalance. DESIGN AND METHODS: In this retrospective observational cohort study twelve patients who previously underwent surgery for sagittal imbalance correction were revised in the period 2009-10. We analyzed angular parameters of sagittal balance before and after primary surgery, type of instrumentation, modality of fusion, implant density, instrumented levels, modality of failure, time from first surgery and angular parameters after revision. RESULTS AND CONCLUSION: Causes of failure were insufficient correction, junctional kyphosis, screw loosening and pseudoarthrosis with rod breakage. In every case, patients presented a new onset or a worsening of sagittal imbalance and pain.
