腰椎间融合技术和比课件

Lumbarinterbodyfusion:Techniques

andcomparison

腰椎间融合技术和比IntroductionLumbarinterbodyfusion(LIF)：placementofanimplant(cage,spacerorstructural

graft)withintheintervertebralspaceafterdiscectomyand

endplatepreparation.FivemainapproachesInterbodyfusion：lowerratesofpostoperativecomplicationsand

pseudoarthrosis腰椎间融合技术和比Techniquereview

PLIFOneoftheoriginalapproachesInitialdescriptionofthePLIFtechniqueby

BriggsandMilliganin1944腰椎间融合技术和比PLIFPLIF腰椎间融合技术和比Techniquereview腰椎间融合技术和比Techniquereview腰椎间融合技术和比Techniquereview

TLIFOpeningtheneural

foramenononesideonly.Harms

andRolingerreportedin1982Direct,unilateral

accesstotheintervertebralforaminalspacewhilst

reducingdirectdissection

and

dural

tears.腰椎间融合技术和比TLIFTLIF腰椎间融合技术和比Preserves

ligamentousstructureswhichareinstrumentaltorestoring

biomechanicalstabilityofthesegmentandadjacent

structuresAsingleunilateralincision

isabletoprovidebilateralanteriorcolumnsupport腰椎间融合技术和比腰椎间融合技术和比Techniquereview

ALIFAnterioraccesscorridorsforlumbarfusionhavebeenusedand

developedsincetheywereintroducedbyCarpenterin1932.Theanteriorretroperitonealapproachtothe

ventralsurfaceoftheexposed

disc,allowingcomprehensivediscectomyanddirectimplant

insertion.Suitable

forlevelsL4/L5andL5/S1腰椎间融合技术和比ALIFALIF腰椎间融合技术和比腰椎间融合技术和比腰椎间融合技术和比腰椎间融合技术和比Disadvantages

Retrograde

ejaculationvisceralandvascularinjury腰椎间融合技术和比Techniquereview

LLIFDescribedbyOzguretal.in2006SuitableforT12to

L5.ThistechniqueisnotsuitablefortheL5/S1level.NeuromonitoringisessentialSuitableforalldegenerative

indications.Especially

forsagittalandcoronal

deformitycorrection,

lumbardegenerative

scoliosiswithlaterolisthesis.Notbesuitableforseverecentralcanal

stenosis,bonylateralrecessstenosisandhigh-grade

spondylolisthesisNotbesuitableforprior

retroperitonealsurgeryorwithretroperitonealabscess,as

wellaspatientswithabnormalvascularanatomy.腰椎间融合技术和比LLIF腰椎间融合技术和比Advantage:MISmuscle-splittingapproachthatcan

beperformedwithrapidpostoperativemobilization.Aggressivedeformitycorrectioncanbeachievedwithhigh

fusionratesandcomprehensivediscspaceclearance.Disadvantages:Potentialrisksoflumbarplexus,

psoasmuscleandbowelinjury,particularlyattheL4/5

level.Vascularinjury,ifitoccurs,maybedifficultto

control.腰椎间融合技术和比Techniquereview

OLIFFirstdescribedbyMichael

Mayerin1997andinvolvesanMISaccesstothe

discspaceviaacorridorbetweentheperitoneumand

psoasmuscleThephrase“obliquelumbarinterbodyfusion”orOLIFwasfirst

coinedbySilvestrein2012SimilarlytoanLLIFapproach,

OLIFdoesnotrequireposteriorsurgery,laminectomy,

facetectomyorstrippingofspinalorparaspinalmusculature.OLIFtechniquedoesnotdissectortraversethepsoas

muscle

and

neuromonitoringisnot

necessary.OLIFtechniqueissuitable

forlevelsL1-S1.Indicationsand

contraindications

are

similartoLLIF腰椎间融合技术和比OLIFOLIF腰椎间融合技术和比Advantage:LLIF+less

risk

of

lumbar

plexus

and

psoas

muscle

damage.Disadvantages:Potential

risksof

includesympathetic

dysfunctionandvascularinjury腰椎间融合技术和比SilvestreC,Mac-ThiongJM,HilmiR,etal.Complicationsandmorbiditiesof

mini-openanteriorretroperitoneallumbarinterbodyfusion:obliquelumbar

interbodyfusionin1