Xu David S, Walker Corey T, Godzik Jakub, Turner Jay D, Smith William, Uribe Juan S
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, University Medical Center, Las Vegas, Nevada, USA.
Ann Transl Med. 2018 Mar;6(6):104. doi: 10.21037/atm.2018.03.24.
Lumbar interbody fusion involves insertion of a structural graft into an intervertebral disc space to promote bony arthrodesis. It is a well-established surgical strategy for multiple spinal disorders ranging from degenerative conditions to trauma, neoplastic diseases, and deformities requiring correction. Since the inception of lumbar interbody fusion, the most established techniques have been two posterior approaches, the posterior lumbar interbody fusion (PLIF) and the transforaminal lumbar interbody fusion (TLIF). Within the past 15 years, multiple anterolateral approaches to the spine have become widely adopted. These approaches can be performed minimally invasively and spare disruption of the paraspinal muscles and posterior spinal column while enabling wide exposure of the disc space for insertion of interbody grafts much larger than PLIF and TLIF instrumentation. This review highlights three minimally invasive anterolateral approaches: the anterior lumbar interbody fusion (ALIF), the transpsoas lateral lumbar interbody fusion (LLIF), and prepsoas or anterior to the psoas oblique lumbar interbody fusion (OLIF). Relevant topics for discussion and comparison include patient selection, surgical techniques, outcomes, and complications for the three surgical approaches.
腰椎椎间融合术包括将结构性移植物植入椎间盘间隙以促进骨性融合。它是一种成熟的手术策略,适用于多种脊柱疾病,从退行性疾病到创伤、肿瘤性疾病以及需要矫正的畸形。自腰椎椎间融合术开展以来,最成熟的技术是两种后路手术,即后路腰椎椎间融合术(PLIF)和经椎间孔腰椎椎间融合术(TLIF)。在过去15年中,多种脊柱前外侧入路已被广泛采用。这些入路可以通过微创方式进行,避免椎旁肌肉和脊柱后柱的破坏,同时能够广泛暴露椎间盘间隙,以便插入比PLIF和TLIF器械大得多的椎间移植物。本综述重点介绍三种微创前外侧入路:前路腰椎椎间融合术(ALIF)、经腰大肌外侧腰椎椎间融合术(LLIF)以及腰大肌前或腰大肌前方斜行腰椎椎间融合术(OLIF)。讨论和比较的相关主题包括三种手术入路的患者选择、手术技术、疗效和并发症。