"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Original article
peer-reviewed

Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results



Abstract

Background

Minimally invasive direct lateral interbody fusion (MIS-DLIF) is a novel approach for fusions of the lumbar spine. In this proof of concept study, we describe the surgical technique and report our experience and the perioperative outcomes of the first nine patients who underwent this procedure.

Study design/setting

In this study we establish the safety and efficacy of this approach. MIS-DLIF was performed on 15 spinal levels in nine patients who failed to respond to conservative therapy for the treatment of a re-herniated disk, spondylolisthesis, or other severe disk disease of the lumbar spine. We recorded surgery time, blood loss, fluoroscopy time, patient-reported pain, and complications.

Methods

Throughout the MIS-DLIF procedure, the surgeon is aided by biplanar fluoroscopic imaging to place an interbody graft or cage into the disc space through the interpleural space. A discectomy is performed in the same minimally invasive fashion. The procedure is usually completed with posterior pedicle screw fixation.

Results

MIS-DLIF took 44/85 minutes, on average, for 1/2 levels, with 54/112 ml of blood loss, and 0.3/1.7 days of hospital stay. Four of nine patients did not require overnight hospitalization and were discharged two to four hours after surgery. We did not encounter any clinically significant complications. At more than ninety days post surgery, the patients reported a statistically significant reduction of 4.5 points on a 10-point sliding pain scale.

Conclusions

MIS-DLIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the lumbar spine. The procedure overcomes many of the limitations of the current minimally invasive approaches to the lumbar spine and is technically straightforward. MIS-DLIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care and therefore warrants further investigation. We are currently expanding this study to a larger cohort and documenting long-term outcome data.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Original article
peer-reviewed

Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results


Author Information

Hamid Abbasi

Tristate Brain and Spine Institute

Ali Abbasi Corresponding Author

Trinity College, University of Cambridge


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Pearl IRB issued approval 16-TRIS-104. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Payment/services info: A medical writer was contracted for manuscript editing. Financial relationships: Hamid Abbasi declare(s) personal fees from Amendia. Dr. Abbasi has been paid fees for training other surgeons in procedures that use Amendia techniques. .

Acknowledgements

Thank you to Kristy Nohl, RN for data collection support.


Original article
peer-reviewed

Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results


Figures etc.

Share
Original article
peer-reviewed

Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results

  • Author Information
    Hamid Abbasi

    Tristate Brain and Spine Institute

    Ali Abbasi Corresponding Author

    Trinity College, University of Cambridge


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Pearl IRB issued approval 16-TRIS-104. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Payment/services info: A medical writer was contracted for manuscript editing. Financial relationships: Hamid Abbasi declare(s) personal fees from Amendia. Dr. Abbasi has been paid fees for training other surgeons in procedures that use Amendia techniques. .

    Acknowledgements

    Thank you to Kristy Nohl, RN for data collection support.


    Article Information

    Published: January 14, 2017

    DOI

    10.7759/cureus.979

    Cite this article as:

    Abbasi H, Abbasi A (January 14, 2017) Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results. Cureus 9(1): e979. doi:10.7759/cureus.979

    Publication history

    Received by Cureus: December 01, 2016
    Peer review began: December 05, 2016
    Peer review concluded: January 05, 2017
    Published: January 14, 2017

    Copyright

    © Copyright 2017
    Abbasi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Minimally invasive direct lateral interbody fusion (MIS-DLIF) is a novel approach for fusions of the lumbar spine. In this proof of concept study, we describe the surgical technique and report our experience and the perioperative outcomes of the first nine patients who underwent this procedure.

Study design/setting

In this study we establish the safety and efficacy of this approach. MIS-DLIF was performed on 15 spinal levels in nine patients who failed to respond to conservative therapy for the treatment of a re-herniated disk, spondylolisthesis, or other severe disk disease of the lumbar spine. We recorded surgery time, blood loss, fluoroscopy time, patient-reported pain, and complications.

Methods

Throughout the MIS-DLIF procedure, the surgeon is aided by biplanar fluoroscopic imaging to place an interbody graft or cage into the disc space through the interpleural space. A discectomy is performed in the same minimally invasive fashion. The procedure is usually completed with posterior pedicle screw fixation.

Results

MIS-DLIF took 44/85 minutes, on average, for 1/2 levels, with 54/112 ml of blood loss, and 0.3/1.7 days of hospital stay. Four of nine patients did not require overnight hospitalization and were discharged two to four hours after surgery. We did not encounter any clinically significant complications. At more than ninety days post surgery, the patients reported a statistically significant reduction of 4.5 points on a 10-point sliding pain scale.

Conclusions

MIS-DLIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the lumbar spine. The procedure overcomes many of the limitations of the current minimally invasive approaches to the lumbar spine and is technically straightforward. MIS-DLIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care and therefore warrants further investigation. We are currently expanding this study to a larger cohort and documenting long-term outcome data.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Hamid Abbasi

Tristate Brain and Spine Institute

Ali Abbasi, Medical Student

Trinity College, University of Cambridge

For correspondence:
biotechdir@gmail.com

Hamid Abbasi

Tristate Brain and Spine Institute

Ali Abbasi, Medical Student

Trinity College, University of Cambridge

For correspondence:
biotechdir@gmail.com