Ivetić Drazen, Spaić Milan, Antić Branislav
Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia.
Srp Arh Celok Lek. 2013 Sep-Oct;141(9-10):671-5. doi: 10.2298/sarh1310671i.
This paper describes the lateral extracavitary approach to the lumbar spine using the three-quarter prone position. Owing to unsatisfied results of the posterior approaches to spine in patients with the ventral compressive lesions, many ventral approaches as well as lateral extracavitary approach have been developed.
A patient with tumor (chordoma) of L3 vertebral body was operated on by means of ventral compression of cauda equina; the tumor had paraspinal propagation. Lateral extracavitary approach was used with a patient in three-quarter prone position, and corpectomy with the anterior stabilisation was performed followed by posterior transpedicular stabilisation through the same approach. Complete tumor removal and excellent neurological improvement were achieved.
This approach provides safe ventral decompression of the spinal cord; it also enables the anterior and posterior instrumental stabilisation through the same incision and in the same position during the intervention. The three-quarter prone position allows excellent view of the dural sac.
本文描述了采用四分之三俯卧位的腰椎外侧腔外入路。由于对于伴有腹侧压迫性病变的患者，脊柱后路手术效果不理想，因此已经开发了多种前路手术以及外侧腔外入路。
一名L3椎体肿瘤（脊索瘤）患者因马尾神经腹侧受压接受手术治疗；肿瘤已向椎旁蔓延。对处于四分之三俯卧位的患者采用外侧腔外入路，进行椎体次全切除并前路固定，随后通过相同入路进行后路经椎弓根固定。实现了肿瘤的完全切除，神经功能得到显著改善。
该入路能安全地对脊髓进行腹侧减压；还能在手术过程中通过同一切口、在同一位置进行前后路器械固定。四分之三俯卧位可提供对硬脊膜囊的良好视野。
