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Lateral Interbody Fusion (DLIF)

in patients with De-Novo Adult

Degenerative Scoliosis Associate Professor of Neurosurgery

Advanced Neurosurgery, Inc

Dayton, OhioInterest: Minimal Invasive Spine

surgery

Jamal Taha, MD

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Lateral Interbody Fusion (DLIF) in

Patients with De-Novo AdultDegenerative Scoliosis

J. Taha, MDNeurosurgery

Kettering Medical NetworkDayton, Ohio USA

Dr. Taha is a consultant for Medtronic

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What is Direct Lateral?

Variation of retroperitonealapproach that is minimallyinvasive

Muscle-splitting TransPsoasapproach

Considered closely similar toanterior approach

Best suited for L1-L5, can bedone in thoracic

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Surgical Procedure

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APPROACH

Obl. Ext M

Obl. Int M

TransversusM.V.Cave

Aorta

Surgical Procedure

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Surgical Procedure

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Distraction

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Distraction

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DLIF in Deg Scoliosis

DLIF is emerging as a viable alternativeto Posterior or Posterior/Anteriorsurgery that is minimally invasive with

less complication rate Can be utilized as a primary correcting

tool for scoliosis or as a secondarystabilizing tool for scoliotic spine

undergoing surgery

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Role of DLIF in Scoliosis Surgery

Advantages* Ant column structural stability

disc height & maintainsdistraction between end plates

regional sagittal & coronalbalance

Indirect neural decompression

Good support for hardware endvertebrae

fusion rate (osteoporosis Anterior release

Unloads facet joints

stress on posterior hardware

? Shorter level instrumentation

Disadvantages Technically more tricky

Rotation Vertebrae

Rotation L-S Plexus

? Inferior to osteotomy inFixed & Rigid Curves.Role may be best forflexible curves and mayhelp in changing PSO toPont osteotomy

*J Neurosurg Spine 7, 2007

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Lateral TransPsoas in Deg Scoliosis

Cobb AVT Lordosis VAS ODI

Anand et al* 227 73 5539

Tormenti et al* 38.510 3.61.8 47.340.4 8.83.5

Dakwar et al* 8.12.4 5329

Wang et al* 31.411.5 37.445.5

Diaz et al+ 188 3441 9.13.2 4919

Patel et al++ 20.211.7

* Neurosurg Focus 28 (3), 2010

++ Superior results to PLIF/TLIF controlled cohort for Cobb angle & AVT

All had blood loss 50-500 ml, less than open surgery (average=2.11 Lit**)

Comparable results for VAS to open surgery (Spinal Deformity Study Group)

** Cho et al: Spine 32, 2007

+ Diaz et al: Spine 2006

++ Patel et al: Spine 2009

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Case RoBack & Leg Pain

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Case Ro: Back & Leg Pain

L4-L5

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Case Ro: Back & Leg Pain

32

9

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Case RoBack & Leg Pain

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Case DG: Back & Leg Pain

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Case DGBack & Leg Pain

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Case DG: Back & Leg Pain

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Case DG

30

45

Back & Leg Pain

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Case DGBack & Leg Pain

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Case JB

1 yr

Back Pain

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Case JB: Back Pain

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Case JB

25

40

Back Pain

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Case LWBack Pain

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Case LW: Back Pain

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Case LW: Back Pain

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Case LW: Back Pain

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Case LW: Back Pain

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Case LW

16

0

Back Pain

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Case LW

5055

Back Pain

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Case Bo: Back & Leg Pain

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Case Bo: Back & Leg Pain

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Case Bo

3210

Back & Leg Pain

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Case Bo

19 39

Back & Leg Pain

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Case Ha

Back Pain

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Case Ha: Back Pain

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Case Ha: Back Pain

24

41

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Case Jo: Back Pain

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Case Jo: Back Pain

103

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Case No

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