Lateral Interbody Fusion (DLIF)

in patients with De-Novo Adult

Degenerative Scoliosis
• Associate Professor of Neurosurgery
•Advanced Neurosurgery, Inc
Dayton, Ohio
•Interest: Minimal Invasive Spine
surgery

Jamal Taha, MD
 Lateral Interbody Fusion (DLIF) in
Patients with De-Novo Adult
Degenerative Scoliosis

J. Taha, MD
Neurosurgery
Kettering Medical Network
Dayton, Ohio USA

Dr. Taha is a consultant for Medtronic

 What is Direct Lateral?
• Variation of retroperitoneal
approach that is minimally
invasive

• Muscle-splitting TransPsoas
approach

• Considered closely similar to

anterior approach

• Best suited for L1-L5, can be

done in thoracic
 Advantages of DLIF
Compared to ALIF
• No need for approach
surgeon
• No retraction of peritoneal
contents
• Easy access to upper
lumbar
• Less risk to vessels &
sympathetics
• Obesity is less of issue
• No resection of ALL
• Less blood loss
Compared to PLIF/TLIF
• No bony resection
• Avoid canal exploration,
root manipulation & root
adhesion pain
• Larger graft
• Obesity is less of issue
• No disruption of Posterior
tension band
• More stable in torsion*
• Less blood loss
• *Voor MJ, Mehta S, Wang M, Zhang YM, Mahan J, Johnson JR.
• Department of Orthopaedic Surgery, University of Louisville School of
Medicine, Kentucky 40292, USA. 1: J Spinal Disord. 1998 Aug;11(4):328-34
Surgical Procedure
Surgical Procedure

Lumbar Plexus Nerves

Moro et al, Spine V 28 N 5 , pp 423- 428, 2003
Surgical Procedure
Obl. Int M
Obl. Ext M Transversus
M.
V. Aorta
Cave

APPROACH
Surgical Procedure
Surgical Procedure
Distraction
Distraction
 DLIF in Deg Scoliosis
• PLIF/TLIF+post instrumentation has ↑ fusion rate & better
alignment compared to post instrumentation alone*
• PLIF is ineffective in restoring sagittal balance***
• Anterior placed graft improves lumbar lordosis more than
posterior placed graft††
• Restoration of sagittal & global balance improves outcomeⱡ &
loss of lumbar lordosis is associated with ↑ pain & ↓ Quality
of life†
• Anterior grafts are more biomechanically stable than
posterior grafts^
• Complication rate of open Deg Scoliosis surgery is high (20-
80%)**
*** Kyu-Jung et al: Eur Spine J, 17: 2008
** Cho et al: Spine 32, 2007
ⱡ Glassman et al: Spine 30, 2005 ** Bone et al: Spine , 30: 2005 ^ Voor et al: J Spinal Disord 11, 1998
* Wu et al: J Spinal Disord Tech 21, 2008 † Ploumis et al: Spine 34, 2009 †† Daffner et al: Am J Orthop, 2: 2003
 DLIF in Deg Scoliosis

• DLIF is emerging as a viable alternative

to Posterior or Posterior/Anterior
surgery that is minimally invasive with
less complication rate
• Can be utilized as a primary correcting
tool for scoliosis or as a secondary
stabilizing tool for scoliotic spine
undergoing surgery
 Role of DLIF in Scoliosis Surgery
Advantages* Disadvantages
• Ant column structural stability • Technically more tricky
• ↑ disc height & maintains – Rotation Vertebrae
distraction between end plates – Rotation L-S Plexus
• ↑ regional sagittal & coronal • ? Inferior to osteotomy in
balance Fixed & Rigid Curves.
• Indirect neural decompression Role may be best for
flexible curves and may
• Good support for hardware end help in changing PSO to
vertebrae Pont osteotomy
• ↑ fusion rate (osteoporosis
• Anterior release
• Unloads facet joints
• ↓ stress on posterior hardware
• ? Shorter level instrumentation *J Neurosurg Spine 7, 2007
Lateral TransPsoas in Deg Scoliosis

Cobb AVT Lordosis VAS ODI

Anand et al* 22°→7° 7→3 55→39
Tormenti et al*† 38.5°→10° 3.6→1.8 47.3°→40.4° 8.8→3.5
Dakwar et al* 8.1→2.4 53→29
Wang et al* 31.4°→11.5° 37.4°→45.5°
Diaz et al+ 18°→8° 34°→41° 9.1→3.2 49→19
Patel et al++ 20.2°→11.7°

†++ Superior results to PLIF/TLIF controlled cohort for Cobb angle & AVT
● Comparable results for VAS to open surgery (Spinal Deformity Study Group)
● All had blood loss 50-500 ml, less than open surgery (average=2.1±1 Lit**)

+ Diaz et al: Spine 2006 * Neurosurg Focus 28 (3), 2010

++ Patel et al: Spine 2009 ** Cho et al: Spine 32, 2007
Case Ro
Back & Leg Pain
Case Ro: Back & Leg Pain
Case Ro: Back & Leg Pain

L4-L5
Case Ro: Back & Leg Pain

32°

9°
Case Ro
Back & Leg Pain
Case DG: Back & Leg Pain
Case DG
Back & Leg Pain
Case DG: Back & Leg Pain
 Case DG
Back & Leg Pain

30°
45°
Case DG
Back & Leg Pain
Case JB
Back Pain

1 yr
Case JB: Back Pain
Case JB: Back Pain

25°
10°
 Case JB
Back Pain

40°
25°
Case LW
Back Pain
Case LW: Back Pain
Case LW: Back Pain
Case LW: Back Pain
Case LW: Back Pain
 Case LW
Back Pain

0°

16°
 Case LW
Back Pain

50°
55°
Case Bo: Back & Leg Pain
Case Bo: Back & Leg Pain
 Case Bo
Back & Leg Pain

10°
32°
 Case Bo
Back & Leg Pain

19° 39°
Case Ha
Back Pain
Case Ha: Back Pain
 Case Ha: Back Pain

3°

10°
Case Ha: Back Pain

41°
24°
Case Jo: Back Pain
Case Jo: Back Pain

10°
3°
Case No
 Conclusion

• Role of DLIF in Degenerative Scoliosis

Surgery is still being defined but is
emerging as a viable option either alone
or in combination with other techniques