腰椎间融合技术和比.ppt

Lumbar interbody fusion:Lumbar interbody fusion:TechniquesTechniques and comparisonand 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 and pseudoarthrosisTechnique reviewTechnique review PLIFPLIFOne of the original approachesInitial description of the PLIF technique by Briggs and Milligan in 1944PLIFPLIFTechnique reviewTechnique reviewTechnique reviewTechnique reviewTechnique reviewTechnique review TLIFTLIFOpening the neural foramen on one side only.Harms and Rolinger reported in 1982 Direct,unilateral access to the intervertebral foraminal space whilst reducing direct dissection and dural tears.TLIFTLIFPreserves ligamentous structures which are instrumental to restoring biomechanical stability of the segment and adjacent structuresA single unilateral incision is able to provide bilateral anterior column supportTechnique reviewTechnique review ALIFALIFAnterior 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 insertion.Suitable for levels L4/L5 and L5/S1ALIFALIFDisadvantagesDisadvantages Retrograde ejaculationvisceral and vascular injuryTechnique reviewTechnique review LLIFLLIFDescribed by Ozgur et al.in 2006Suitable for T12 to L5.This technique is not suitable for the L5/S1 level.Neuromonitoring is essentialSuitable for all degenerative 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 spondylolisthesisNot be suitable for prior retroperitoneal surgery or with retroperitoneal abscess,as well as patients with abnormal vascular anatomy.LLIFAdvantage: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:Potential 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 reviewTechnique review OLIFOLIFFirst described by Michael Mayer in 1997 and involves an MIS access to the disc space via a corridor between the peritoneum and psoas muscleThe phrase“oblique lumbar interbody fusion”or OLIF was first coined by Silvestre in 2012Similarly 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 muscle and neuromonitoring is not necessary.OLIF technique is suitable for levels L1-S1.Indications and contraindications are similar to LLIFOLIFOLIFAdvantage:LLIF+less risk of lumbar plexus and psoas muscle 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，供参考！感谢您的支持，我们努力做得更好！