腰椎前路椎间融合术(ALIF)的现代应用:围手术期注意事项及手术要点的叙述性综述

The modern application of anterior lumbar interbody fusion (ALIF): a narrative review of perioperative considerations and surgical pearls.

作者信息

Khela Monty, Agha Obiajulu, Sawires Andrew, Metz Lionel

机构信息

Creighton University School of Medicine, Omaha, NE, USA.

Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA.

出版信息

J Spine Surg. 2025 Mar 24;11(1):148-165. doi: 10.21037/jss-24-85. Epub 2025 Feb 18.

Abstract

BACKGROUND AND OBJECTIVE

Anterior lumbar interbody fusion (ALIF) has become a pivotal technique in managing chronic back pain, radiculopathy, neurogenic claudication, and spinal deformity. This review aims to compare ALIF with other fusion methods, highlight its advantages and disadvantages, and provide surgical insights to enhance perioperative outcomes.

METHODS

A comprehensive literature search was conducted using databases such as PubMed, Embase, and Cochrane Library, focusing on publications from the past two decades. Articles were selected based on relevance, study design, and the inclusion of key perioperative considerations and surgical techniques. Only English-language studies were considered.

KEY CONTENT AND FINDINGS

This review examines the historical evolution of ALIF, its current clinical applications, and the development of associated surgical techniques. It discusses preoperative evaluations, imaging strategies, and patient selection criteria. Key findings highlight that ALIF offers superior disc height restoration and segmental lordosis compared to other fusion techniques. However, it presents unique challenges such as potential vascular and visceral injuries. The review also outlines critical surgical pearls for effective ALIF execution and strategies to mitigate common complications like subsidence and nerve root injuries.

CONCLUSIONS

ALIF is a robust technique for lumbar spine pathology, providing significant benefits in appropriate patient populations. This review underscores the importance of meticulous surgical planning and technique to optimize outcomes. Future research should focus on long-term comparative studies and the development of enhanced surgical instruments and protocols. Implementing these insights into clinical practice may improve patient outcomes and influence surgical guidelines and policies.

摘要

背景与目的

腰椎前路椎间融合术(ALIF)已成为治疗慢性背痛、神经根病、神经源性间歇性跛行和脊柱畸形的关键技术。本综述旨在比较ALIF与其他融合方法,突出其优缺点,并提供手术见解以提高围手术期疗效。

方法

使用PubMed、Embase和Cochrane图书馆等数据库进行全面的文献检索,重点关注过去二十年的出版物。根据相关性、研究设计以及是否纳入关键围手术期考虑因素和手术技术来选择文章。仅考虑英文研究。

关键内容与发现

本综述考察了ALIF的历史演变、其当前临床应用以及相关手术技术的发展。讨论了术前评估、影像学策略和患者选择标准。关键发现突出表明,与其他融合技术相比,ALIF在恢复椎间盘高度和节段性前凸方面具有优势。然而,它也带来了诸如潜在血管和内脏损伤等独特挑战。该综述还概述了有效实施ALIF的关键手术要点以及减轻下沉和神经根损伤等常见并发症的策略。

结论

ALIF是一种用于腰椎疾病的可靠技术,在合适的患者群体中具有显著益处。本综述强调了精心的手术规划和技术对于优化疗效的重要性。未来研究应侧重于长期比较研究以及开发改进的手术器械和方案。将这些见解应用于临床实践可能会改善患者预后并影响手术指南和政策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9a/11998050/739bb4167a92/jss-11-01-148-f1.jpg

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