The Malaysian doctors encountered some trouble when performing XLIF (NuVasive). They flied to Taipei and wanted to know what was the difference between XLIF and my designed cage using lateral access.
They were told by XLIF Co. that stand-alone XLIF cage was effective. Also, by elevating the disc height, posterior spinal stenosis might be relieved (so called indirect decompression) and no need to do decompression.
My replies were:
1. stand-alone cage has been shown that it cannot control extension and rotation. This biomechanical fact has been repeated in several papers, unless XLIF rectangular cage has some secret stabilizing mechanism built-in (a case report of XLIF cage migration). I am wondering whether NuVasive says the same to all western surgeons including Asian ones.
2. Indirect decompression by using cage to elevate disc height is a wishful thinking. I would like to say that decompression procedure is such a simple job. Why not spend a little time to do it and go home sleep tight? Instead of leaving the decompression to the cage, and worrying about the actual outcome?
They said it took about an hour to setup the whole operating set including probing the nerves inside the psoas muscle before starting lateral fusion procedure. I was joking that when you finish the setup, I had already left the operating table and sipping a cup of espresso.
Even they used neuromonitoring, patients still had paresthesia of the thigh. Some most recent papers show that there was no safe zone or narrow margin of safety for the nerves when performing trans-psoas approach. The most secure way is to retract the psoas muscle and use the muscle to protect the nerves.
I told them my principle: respect the anatomy, don't burn the bridge, you or others may have to go back again.
沒有留言:
張貼留言