Mehren Christoph, Mayer H Michael, Siepe Christoph, Grochulla Frank, Korge Andreas
Wirbelsäulenzentrum, Orthopädische Klinik München-Harlaching, München-Harlaching.
Oper Orthop Traumatol. 2010 May;22(2):221-8. doi: 10.1007/s00064-010-8054-5.
Minimally invasive anterolateral retroperitoneal approach to the lumbar spinal levels L2-L5.
Anterior interbody fusion for the treatment of degenerative disk disease (DDD), degenerative instability, isthmic and degenerative spondylolisthesis, tumors, degenerative scoliosis, fractures, spondylodiscitis, failed back syndrome (pseudarthrosis, post-diskectomy).
No absolute contraindications. Relative contraindications are previous surgeries via a sinistral retroperitoneal approach or a far lateral anatomy of the left iliac common vein covering the lateral annulus of the disk space L4/5.
A small skin incision over the left abdominal wall is followed by a blunt muscle-splitting approach to the retroperitoneal space and the anterolateral circumference of the lumbar spine. A diskectomy, corporectomy and/or grafting (iliac crest or cage) may be performed for a solid ventral fusion.
Early mobilization from the 1st postoperative day in all cases of combined ALIF (anterior lumbar interbody fusion)/ posterior instrumentation procedures. Thromboembolic prophylaxis with fractionated heparin. Light meals up until recovery of the first bowel movements. A brace is recommended depending on the type of the intervention for a duration of up to 12 weeks. No limitations for standing, walking or sitting in the immediate postoperative period.
Minimally invasive anterior interbody fusion procedures with iliac crest bone graft were performed in 120 patients (average age 56.3 years, range 26-84 years) in combination with a dorsal instrumentation. 16 patients were treated with a double-level procedure. Duration of surgery ranged between 50 and 192 min (mean 102.2 min). The intraoperative blood loss was 67.3 cm(3). At the 6-month follow-up, the fusion rate was 95.6%. No vessel, bowel, kidney or spleen injuries were observed.
采用微创前外侧腹膜后入路处理L2 - L5腰椎节段。
前路椎间融合术用于治疗退行性椎间盘疾病（DDD）、退行性不稳定、峡部裂和退行性椎体滑脱、肿瘤、退行性脊柱侧凸、骨折、脊椎椎间盘炎、失败的背部综合征（假关节形成、椎间盘切除术后）。
无绝对禁忌证。相对禁忌证为既往经左侧腹膜后入路手术或左髂总静脉走行异常覆盖L4/5椎间盘间隙外侧纤维环。
在左腹壁做一小切口，然后采用钝性肌劈开入路进入腹膜后间隙及腰椎前外侧周缘。可进行椎间盘切除术、椎体切除术和/或植骨（髂嵴或椎间融合器）以实现牢固的前路融合。
所有联合前路腰椎椎间融合术（ALIF）/后路内固定手术的患者术后第1天即可早期活动。采用低分子肝素预防血栓栓塞。在首次排便恢复前给予清淡饮食。根据手术类型建议佩戴支具，持续时间最长可达12周。术后即刻对站立、行走或坐姿无限制。
120例患者（平均年龄56.3岁，范围26 - 84岁）采用微创前路椎间融合术并取自体髂嵴骨移植，同时行后路内固定。16例患者接受双节段手术。手术时间为50至192分钟（平均102.2分钟）。术中失血量为67.3立方厘米。在6个月随访时，融合率为95.6%。未观察到血管、肠道、肾脏或脾脏损伤。
