腰椎間融合技術(shù)和比

Lumbarinterbodyfusion:Techniquesandcomparison

2021/10/101IntroductionLumbarinterbodyfusion(LIF)：placementofanimplant(cage,spacerorstructural

graft)withintheintervertebralspaceafterdiscectomyand

endplatepreparation.FivemainapproachesInterbodyfusion：lowerratesofpostoperativecomplicationsand

pseudoarthrosis2021/10/102Techniquereview

PLIFOneoftheoriginalapproachesInitialdescriptionofthePLIFtechniqueby

BriggsandMilliganin19442021/10/103PLIFPLIF2021/10/104Techniquereview2021/10/105Techniquereview2021/10/106Techniquereview

TLIFOpeningtheneural

foramenononesideonly.Harms

andRolingerreportedin1982Direct,unilateral

accesstotheintervertebralforaminalspacewhilst

reducingdirectdissection

and

dural

tears.2021/10/107TLIFTLIF2021/10/108Preserves

ligamentousstructureswhichareinstrumentaltorestoring

biomechanicalstabilityofthesegmentandadjacent

structuresAsingleunilateralincision

isabletoprovidebilateralanteriorcolumnsupport2021/10/1092021/10/1010Techniquereview

ALIFAnterioraccesscorridorsforlumbarfusionhavebeenusedand

developedsincetheywereintroducedbyCarpenterin1932.Theanteriorretroperitonealapproachtothe

ventralsurfaceoftheexposed

disc,allowingcomprehensivediscectomyanddirectimplant

insertion.Suitable

forlevelsL4/L5andL5/S12021/10/1011ALIFALIF2021/10/10122021/10/10132021/10/10142021/10/1015Disadvantages

Retrograde

ejaculationvisceralandvascularinjury2021/10/1016Techniquereview

LLIFDescribedbyOzguretal.in2006SuitableforT12to

L5.ThistechniqueisnotsuitablefortheL5/S1level.NeuromonitoringisessentialSuitableforalldegenerative

indications.Especially

forsagittalandcoronal

deformitycorrection,

lumbardegenerative

scoliosiswithlaterolisthesis.Notbesuitableforseverecentralcanal

stenosis,bonylateralrecessstenosisandhigh-grade

spondylolisthesisNotbesuitableforprior

retroperitonealsurgeryorwithretroperitonealabscess,as

wellaspatientswithabnormalvascularanatomy.2021/10/1017LLIF2021/10/1018Advantage:MISmuscle-splittingapproachthatcan

beperformedwithrapidpostoperativemobilization.Aggressivedeformitycorrectioncanbeachievedwithhigh

fusionratesandcomprehensivediscspaceclearance.Disadvantages:Potentialrisksoflumbarplexus,

psoasmuscleandbowelinjury,particularlyattheL4/5

level.Vascularinjury,ifitoccurs,maybedifficultto

control.2021/10/1019Techniquereview

OLIFFirstdescribedbyMichael

Mayerin1997andinvolvesanMISaccesstothe

discspaceviaacorridorbetweentheperitoneumand

psoasmuscleThephrase“obliquelumbarinterbodyfusion”orOLIFwasfirst

coinedbySilvestrein2012SimilarlytoanLLIFapproach,

OLIFdoesnotrequireposteriorsurgery,laminectomy,

facetectomyorstrippingofspinalorparaspinalmusculature.OLIFtechniquedoesnotdissectortraversethepsoas

muscle

and

neuromonitoringisnot

necessary.OLIFtechniqueissuitable

forlevelsL1-S1.Indicationsand

contraindications

are

similartoLLIF2021/10/1020OLIFOLIF2021/10/1021Advantage:LLIF+less

risk

of

lumbar

plexus

and

psoas

muscle

damage.Disadvantages:Potential

risksof

includesympathetic

dysfunctionandvascularinjury2021/10/1022SilvestreC,Mac-ThiongJM,HilmiR,etal.Complicationsandmorbiditiesof

mini-openanteriorretroperitoneallumbarinterbodyfusion:obliquelumbar

interbodyfusionin179patients.AsianSpineJ201