1、Lumbar interbody fusion:Techniques and comparisonIntroductionLumbar interbody fusion(LIF)：placement of an implant(cage,spacer or structural graft)within the intervertebral space after discectomy and endplate preparation.Five main approachesInterbody fusion：lower rates of postoperative complications
2、and pseudoarthrosisTechnique review PLIF One of the original approaches Initial description of the PLIF technique by Briggs and Milligan in 1944PLIFPLIFTechnique reviewTechnique reviewTechnique review TLIF Opening the neural foramen on one side only.Harms and Rolinger reported in 1982 Direct,unilate
3、ral access to the intervertebral foraminal space whilst reducing direct dissection and dural tears.TLIFTLIF Preserves ligamentous structures which are instrumental to restoring biomechanical stability of the segment and adjacent structures A single unilateral incision is able to provide bilateral an
4、terior column supportTechnique review ALIF Anterior access corridors for lumbar fusion have been used and developed since they were introduced by Carpenter in 1932.The anterior retroperitoneal approach to the ventral surface of the exposed disc,allowing comprehensive discectomy and direct implant in
5、sertion.Suitable for levels L4/L5 and L5/S1ALIFALIFDisadvantages Retrograde ejaculation visceral and vascular injuryTechnique review LLIF Described by Ozgur et al.in 2006 Suitable for T12 to L5.This technique is not suitable for the L5/S1 level.Neuromonitoring is essential Suitable for all degenerat
6、ive indications.Especially for sagittal and coronal deformity correction,lumbar degenerative scoliosis with laterolisthesis.Not be suitable for severe central canal stenosis,bony lateral recess stenosis and high-grade spondylolisthesis Not be suitable for prior retroperitoneal surgery or with retrop
7、eritoneal abscess,as well as patients with abnormal vascular anatomy.LLIF Advantage:MIS muscle-splitting approach that can be performed with rapid postoperative mobilization.Aggressive deformity correction can be achieved with high fusion rates and comprehensive disc space clearance.Disadvantages:Po
8、tential risks of lumbar plexus,psoas muscle and bowel injury,particularly at the L4/5 level.Vascular injury,if it occurs,may be difficult to control.Technique review OLIF First described by Michael Mayer in 1997 and involves an MIS access to the disc space via a corridor between the peritoneum and p
9、soas muscle The phrase“oblique lumbar interbody fusion”or OLIF was first coined by Silvestre in 2012 Similarly to an LLIF approach,OLIF does not require posterior surgery,laminectomy,facetectomy or stripping of spinal or paraspinal musculature.OLIF technique does not dissect or traverse the psoas mu
10、scle and neuromonitoring is not necessary.OLIF technique is suitable for levels L1-S1.Indications and contraindications are similar to LLIFOLIFOLIF Advantage:LLIF+less risk of lumbar plexus and p s o a s m u s c l e damage.Disadvantages:Potential risks of include sympathetic dysfunction and vascular injurySilvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities ofmini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbarinterbody fusion in 179 patients.Asian Spine J 2012;6:8997.此课件下载可自行编辑修改，此课件供参考！此课件下载可自行编辑修改，此课件供参考！部分内容来源于网络，如有侵权请与我联系删除！部分内容来源于网络，如有侵权请与我联系删除！
