New technique safely allows lateral interbody fusion without the need for repositioning


According to a study presented at ISASS12, by Ali Araghi, The Core Institute, Phoenix, USA, the Guyer lumbar interbody fusion (GLIF) procedure offers the unique advantage of allowing surgeons to perform interbody fusion with the patient in the prone position without the need for a repositioning “flip”.

Araghi reported that GLIF is a new technique to treat degenerative disc disease, coronal and saggittal plane deformities or both. He said: “In the GLIF procedure, patients were positioned prone. Hence, the surgeon had the ability of implanting pedicle screws, distracting the disc space, or correcting sagittal or coronal plane deformities prior to advancing with the GLIF cage across the disc space but after having done an anterior column release, without the need for repositioning.”

He explained that the technique starts by “targeting apparatus to localise the optimum skin incision position for a curvilinear approach to the lateral aspect of the disc” and added that the dorsolateral aspect of the spine is navigated via a retroperitoneal approach through serial dilators placed and guided by the same targeting apparatus. This is then followed by the psoas being separated, with the assistance of neuromonitoring, and a curved port being placed on the lateral aspect of the disc and fixated with bone pins and tangs. Araghi said: “Expansion of the concave side of the curved port will now allow direct visualisation of the disc space.”

In their multicentre, retrospective study, Araghi et al assessed the safety and efficacy of the GLIF technique. Araghi said: “A total of 40 cases and 47 levels were performed: 35 single levels, three double levels and two triple levels.”  According to Araghi, there were no GLIF-related complications except for one case of quad weakness and pain. However at the one-year follow-up point, although there was some residual thigh pain, the weakness had resolved. The average time to discharge was 3.6 days. Araghi reported: “It is important to note that 24 out of the 40 cases included multilevel posterior decompression or fusions and/or removal of hardware from adjacent levels.”

Araghi concluded that the new procedure “safely allowed” lateral interbody fusion without the need for lateral positioning or a “repositioning flip. He told Spinal News International that there were two advantages of the GLIF procedure, “The GLIF procedure not only saves time in the operating room, by allowing the surgeon to eliminate the lateral set up and the flipping to a prone position, but also enables the surgeon to access all three columns of the spine simultaneously. This allows the surgeon to perform posteriorly based sagittal and coronal plane correction manoeuvres after an anterior release/discectomy, but prior to placing the GLIF anterior column support cage.  This enables the surgeon to optimise the intra-operative correction.”