腰椎间融合技术和比课件

Lumbarinterbodyfusion:Lumbarinterbodyfusion:TechniquesTechniques andcomparisonandcomparisonLumbarinterbodyfusion:Techn1IntroductionLumbarinterbodyfusion(LIF)：placementofanimplant(cage,spacerorstructuralgraft)withintheintervertebralspaceafterdiscectomyandendplatepreparation.FivemainapproachesInterbodyfusion：lowerratesofpostoperativecomplicationsandpseudoarthrosisIntroductionLumbarinterbodyf2TechniquereviewTechniquereview PLIFPLIFOneoftheoriginalapproachesInitialdescriptionofthePLIFtechniquebyBriggsandMilliganin1944TechniquereviewPLIFOneofth3PLIFPLIFPLIFPLIF4TechniquereviewTechniquereviewTechniquereview5TechniquereviewTechniquereviewTechniquereview6TechniquereviewTechniquereview TLIFTLIFOpeningtheneuralforamenononesideonly.HarmsandRolingerreportedin1982Direct,unilateralaccesstotheintervertebralforaminalspacewhilstreducingdirectdissectionandduraltears.TechniquereviewTLIF7TLIFTLIFTLIFTLIF8PreservesligamentousstructureswhichareinstrumentaltorestoringbiomechanicalstabilityofthesegmentandadjacentstructuresAsingleunilateralincisionisabletoprovidebilateralanteriorcolumnsupportPreservesligamentousstructur9腰椎间融合技术和比课件10TechniquereviewTechniquereview ALIFALIFAnterioraccesscorridorsforlumbarfusionhavebeenusedanddevelopedsincetheywereintroducedbyCarpenterin1932.Theanteriorretroperitonealapproachtotheventralsurfaceoftheexposeddisc,allowingcomprehensivediscectomyanddirectimplantinsertion.SuitableforlevelsL4/L5andL5/S1TechniquereviewALIF11ALIFALIFALIFALIF12腰椎间融合技术和比课件13腰椎间融合技术和比课件14腰椎间融合技术和比课件15DisadvantagesDisadvantagesRetrogradeejaculationvisceralandvascularinjuryDisadvantagesRetrogradeeja16TechniquereviewTechniquereview LLIFLLIFDescribedbyOzguretal.in2006SuitableforT12toL5.ThistechniqueisnotsuitablefortheL5/S1level.NeuromonitoringisessentialSuitableforalldegenerativeindications.Especiallyforsagittalandcoronaldeformitycorrection,lumbardegenerativescoliosiswithlaterolisthesis.Notbesuitableforseverecentralcanalstenosis,bonylateralrecessstenosisandhigh-gradespondylolisthesisNotbesuitableforpriorretroperitonealsurgeryorwithretroperitonealabscess,aswellaspatientswithabnormalvascularanatomy.TechniquereviewLLIF17LLIFLLIF18Advantage:MISmuscle-splittingapproachthatcanbeperformedwithrapidpostoperativemobilization.Aggressivedeformitycorrectioncanbeachieved with high fusion rates andcomprehensivediscspaceclearance.Disadvantages:Potentialrisksoflumbarplexus,psoasmuscleandbowelinjury,particularlyattheL4/5level.Vascular injury,if it occurs,may bedifficulttocontrol.Advantage:19TechniquereviewTechniquereview OLIFOLIFFirstdescribedbyMichaelMayerin1997andinvolvesanMISaccesstothediscspaceviaacorridorbetweentheperitoneumandpsoasmuscleThephrase“obliquelumbarinterbodyfusion”orOLIFwasfirstcoinedbySilvestrein2012SimilarlytoanLLIFapproach,OLIFdoesnotrequireposteriorsurgery,laminectomy,facetectomyorstrippingofspinalorparaspinalmusculature.OLIFtechniquedoesnotdissectortraversethepsoasmuscleandneuromonitoringisnotnecessary.OLIFtechniqueissuitableforlevelsL1-S1.IndicationsandcontraindicationsaresimilartoLLIFTechniquereviewOLIFFirstdes20OLIFOLIFOLIFOLIF21Advantage:LLIF+lessriskoflumbarplexusandpsoasmuscledamage.Disadvantages:PotentialrisksofincludesympatheticdysfunctionandvascularinjuryAdvantage:22SilvestreC,Mac-ThiongJM,HilmiR,etal.Complicationsandmorbiditiesofmini-openanteriorretroperitoneallumbarinterbodyfusion:obliquelumbarinterbodyfusionin179patients.AsianSpineJ2012;6:8997.SilvestreC,Mac-ThiongJM,Hi23腰椎间融合技术和比课件24腰椎间融合技术和比课件25腰椎间融合技术和比课件26腰椎间融合技术和比课件27腰椎间融合技术和比课件28腰椎间融合技术和比课件29腰椎间融合技术和比课件30腰椎间融合技术和比课件31腰椎间融合技术和比课件32腰椎间融合技术和比课件33腰椎间融合技术和比课件34腰椎间融合技术和比课件35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！此课件下载可自行编辑修改，此课件供参考！36