Eck Jason C, Hodges Scott, Humphreys S Craig
Department of Orthopaedic Surgery, Memorial Hospital, York, PA, USA.
J Am Acad Orthop Surg. 2007 Jun;15(6):321-9. doi: 10.5435/00124635-200706000-00001.
Minimally invasive techniques for lumbar spine fusion have been developed in an attempt to decrease the complications related to traditional open exposures (eg, infection, wound healing problems). Anterior minimally invasive procedures include laparoscopic and mini-open anterior lumbar interbody fusion as well as the lateral transpsoas and percutaneous presacral approaches. Posterior techniques typically use a tubular retractor system that avoids the muscle stripping associated with open procedures. These techniques can be applied to both posterior and transforaminal lumbar interbody fusion procedures. Many initial reports have shown similar clinical results in terms of spinal fusion rates for both traditional open and minimally invasive posterior approaches. However, the anterior minimally invasive procedures are often associated with significantly greater incidence of complications and technical difficulty than their associated open approaches. There is a steep learning curve associated with minimally invasive techniques, and surgeons should not expect to master them in the first several cases.
腰椎融合的微创技术已被开发出来，旨在减少与传统开放手术相关的并发症（如感染、伤口愈合问题）。前路微创技术包括腹腔镜和迷你开放前路腰椎椎间融合术，以及经腰大肌外侧和经皮骶前入路。后路技术通常使用管状牵开器系统，避免了与开放手术相关的肌肉剥离。这些技术可应用于后路和经椎间孔腰椎椎间融合手术。许多初步报告显示，传统开放和微创后路手术在脊柱融合率方面的临床结果相似。然而，前路微创技术通常比其相关的开放手术并发症发生率和技术难度显著更高。微创技术存在陡峭的学习曲线，外科医生不应期望在最初的几例手术中就能掌握它们。
