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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,1,Lumbar interbody fusion: Techniques,and comparison,1Lumbar interbody fusion: Tech,2,Introduction,?,Lumbar interbody fusion (LIF),：,placement of an implant (cage,spacer or structural,graft) within the intervertebral space after,discectomy and,endplate preparation.,?,Five main approaches,?,Interbody fusion,：,lower rates of,postoperative complications and,pseudoarthrosis,2Introduction?Lumbar interbody,3,Technique review,PLIF,?,One of the original approaches,?,Initial description of the PLIF technique by,Briggs and Milligan in,1944,3Technique reviewPLIF?One of t,4,PLIF,PLIF,4PLIFPLIF,5,Technique review,5Technique review,6,Technique review,6Technique review,7,Technique review,TLIF,?,Opening 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.,7Technique reviewTLIF?Opening,8,TLIF,TLIF,8TLIFTLIF,9,?,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 anterior,column support,9?Preservesligamentous structu,10,10,11,Technique 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,insertion.,?,Suitable,for levels L4/L5 and L5/S1,11Technique reviewALIF?Anterio,12,ALIF,ALIF,12ALIFALIF,13,13,14,14,15,15,16,Disadvantages,?,Retrograde,ejaculation,?,visceral and vascular injury,16Disadvantages?Retrogradeejac,17,Technique 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 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,spondylolisthesis,?,Not be suitable for prior,retroperitoneal surgery or with,retroperitoneal abscess, as,well as patients with abnormal vascular,anatomy.,17Technique reviewLLIF?Describ,18,LLIF,18LLIF,19,?,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:,?,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.,19?Advantage:?MISmuscle-splitt,20,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,psoas 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,muscle,and,neuromonitoring is not,necessary.,?,OLIF technique is suitable,for levels L1-S1.,?,Indications and,contraindications,are,similar to LLIF,20Technique reviewOLIF?First d,21,OLIF,OLIF,21OLIFOLIF,22,?,Advantage:,?,LLIF+less,risk,of,lumbar,plexus,and,psoas,muscle,damage.,?,Disadvantages:,?,Potential,risks of,include sympathetic,dysfunction and,vascular injury,22?Advantage:?LLIF+lessriskofl,23,Silvestre,C,Mac-Thiong,JM,Hilmi,R,et,al.,Complications,and,morbidities,of,mini-open,anterior,retroperitoneal,lumbar,interbody,fusion:,oblique,lumbar,interbody,fusion,in,179,patients.,Asian,Spine,J,2012;6:89,97.,23SilvestreC,Mac-ThiongJM,Hilm,24,24,25,25,26,26,27,27,28,28,29,29,30,30,31,31,32,32,33,33,34,34,35,35,
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