Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2022 Dec;168:4-10. doi: 10.1016/j.wneu.2022.09.012. Epub 2022 Sep 10.
Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion are common techniques that typically require staged procedures when performed in combination. Interest is emerging in single-position surgery to increase operative efficiency. We report a novel surgical technique, supine extended reach lateral fusion, to perform ALIF and lateral lumbar interbody fusion with the patient in a single supine position.
A man in his fifties presented with degenerative levoscoliosis, spondylolisthesis, sagittal plane deformity, and progressive low back pain. He was offered L3-S1 anterolateral fusion.
With the patient supine, a left abdominal paramedian incision was performed to gain anterior retroperitoneal access, and standard L5-S1 and L4-5 ALIFs were performed. The anterior incision was used for direct visualization, retraction, and bimanual dissection. A left lateral incision was then made to perform an L3-4 lateral lumbar interbody fusion. He subsequently underwent a second-stage L3-S1 posterior percutaneous fixation. The patient tolerated the procedures well, without complications. His postoperative radiograph findings confirmed acceptable implant positioning. He was discharged home in stable condition and was doing well at follow-up.
This case description is the first report of the supine extended reach technique, which allows incorporation of anterior and lateral fusion constructs at adjacent levels without changing patient positioning. Many surgeons believe the ALIF to be the most powerful technique for achieving lordosis, and this technique enables concomitant lateral access in a supine position. It can also be used as an alternative strategy when anterior access to the disc space is unobtainable. Further clinical investigation of this technique is warranted.
前路腰椎体间融合术（ALIF）和侧路腰椎体间融合术是常见的技术，当联合使用时通常需要分阶段进行。人们对单次手术以提高手术效率的兴趣日益增加。我们报告了一种新的手术技术，即仰卧位延长侧方融合术，可使患者在单一仰卧位下进行 ALIF 和侧路腰椎体间融合术。
一位五十多岁的男性患者表现为退行性左脊柱侧凸、脊椎滑脱、矢状面畸形和进行性腰痛。他被建议进行 L3-S1 前路融合术。
患者仰卧位，行左侧经腹旁正中切口，进入腹膜后前方，完成标准的 L5-S1 和 L4-5ALIF。前切口用于直接可视化、牵开和双手分离。然后行左侧侧方切口进行 L3-4 侧路腰椎体间融合术。随后进行第二期 L3-S1 后路经皮固定。患者术后恢复良好，无并发症。术后 X 线片结果证实了可接受的植入物位置。他稳定出院，随访情况良好。
本病例报告是首例仰卧位延长 reach 技术的报告，该技术可在不改变患者体位的情况下，在相邻节段融合前、后结构。许多外科医生认为 ALIF 是实现脊柱前凸的最有效技术，该技术可在仰卧位时进行同期侧方入路。当无法从前路进入椎间盘间隙时，也可将其作为替代策略。需要进一步的临床研究来验证该技术。
