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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EOverall, while lateral surgery provides good outcomes for appropriate cases, it can also present challenges that must be recognized and managed. In this session, presenters reviewed various aspects of the lateral approach.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EOverall, while lateral surgery provides good outcomes for appropriate cases, it can also present challenges that must be recognized and managed. In this session, presenters reviewed various aspects of the lateral approach.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAndrew A. Sama, MD, Hospital for Special Surgery, New York, New York, USA, provided an overview of indications for the use of lateral surgery. The lateral approach was originally used as a less invasive technique that could preserve abdominal muscles. As surgeons have become more comfortable with the technique, indications for the use of lateral surgery have expanded, including interbody fusion, correction of coronal and sagittal deformity, interbody access in obese patients, adjacent segment access, and a retropleural approach to the thoracic spine or thoracolumbar junction. The lateral approach can also be used for an anterior retroperitoneal approach for trauma, infection, or tumor and for hardware removal for failed interbody fusions above L5. Dr Sama illustrated these points with case studies that demonstrate outcomes over several years (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15385\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15385\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15385\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ELateral Approach Outcomes in Several Case Studies\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ETo conclude, Dr Sama noted that indications can continue to evolve as surgeons better understand the approach.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAlexander P. Hughes, MD, Hospital for Special Surgery, New York, New York, USA, discussed lateral surgery in deformity correction. He first reviewed indications, including interbody fusion T12\u2013L5, degenerative scoliosis, degenerative disc disease, adjacent segment disease, nonunion, and degenerative spondylolisthesis. He then discussed the therapeutic targets, such as nerve compression, spondylolisthesis, coronal deformity, sagittal deformity, and fracture.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ESome studies have suggested that decompression and laminectomy are more efficacious than more complex surgical treatment. One study compared minimally invasive surgery with open surgery [Dangelmajer S et al. \u003Cem\u003ENeurosurg Focus\u003C\/em\u003E. 2014], while another compared interspinous process spacer, laminectomy, and laminectomy with fusion [Brodke DS et al. \u003Cem\u003ESpine (Phila PA 1976\u003C\/em\u003E). 2013]. Dr Hughes noted that the patients in these populations have an average curve magnitude of about 15\u00b0; however, he believes that the lateral approach is best for those who have greater curvature and who will not do well with decompression alone. He stated that it is important to be careful in patient selection for this surgery. For the stand-alone lateral approach, the stability of the segment, coronal and sagittal balance, bone quality, and connective tissue envelope should all be considered.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EJoseph M. Zavatsky, MD, Florida Orthopaedic Institute, Tampa, Florida, USA, addressed the risks and pitfalls of lateral surgery. He noted important benefits of minimally invasive surgery, including lower complication rates, reduced blood loss, and shorter hospital stays. These benefits may contribute to better patient outcomes. Additional benefits are located in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15386\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15386\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15386\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EStudies that Support Advantages of Lateral Approaches\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EMajor risks include inappropriate patient selection, difficulty with patient positioning, problems with the locations of vessels, choosing the incorrect approach (convexity vs concavity), limited access to L45, and limited rotational, sagittal, and lordosis correction. There is also the possibility of neurologic deficits, bowel perforation, or vascular injury.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr Zavatsky suggested looking at x-rays to ensure the use of a true lateral approach, minimizing incisions and operational time, limiting the use of shavers to protect bone, approaching from the left to reduce risks of vessel damage, and paying attention to the computed tomography scan. He concluded by emphasizing the importance of good positioning, an understanding of anatomy, knowledge of rotational deformity in scoliosis, and awareness of arteries. Neurological monitoring and paying special attention to patients with previous abdominal or vascular surgery are also important. Surgeons must respect the end plates and use a larger cage for osteoporosis cases. Additionally, surgery should be aborted if anatomy is uncertain, there is no safe corridor, neural elements are present on the annulus, or monitoring fails in some way.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe final talk of the session was presented by Frank P. Cammisa Jr, MD, Hospital for Special Surgery, New York, New York, USA, who addressed the future of lateral surgery. He reviewed classic vs mini-open approaches, followed by potential improvements in retractors to allow better visualization and stabilization of the surgical corridor. As instrument designs are improved, articulating instruments may be developed that allow easy access around corners. The ability to use single positioning for both lateral and anterior approaches would simplify surgery and is under development. Because damage to the lumbar plexus is a risk during surgery, improved options to monitor and protect it will help to reduce the risk of palsies.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAdding titanium coating to poly-ether-ether-ketone and using titanium substrates is an improvement because it is hydrophilic and promotes better integration, especially if the texture is appropriate to maximize bony on-growth [Olivares-Navarrete R et al. \u003Cem\u003ESpine J.\u003C\/em\u003E 2012]. Other improvements in design are also under development. Biologics such as autogenous bone graft, bone morphogenetic protein 2, demineralized bone matrix, synthetics, and bone mineral area mass concentrators are also options.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EDr Cammisa concluded by summarizing that improved access in minimally invasive approaches, ways to address deformity, improvements to materials and designs, improved fixation, and new approaches to using biologics will help to improve surgical approaches in the future.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/50\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzltc2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzltc2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}