LAPAROSCOPIC LUMBAR INTERBODY SPINAL FUSION - 06/09/11
Résumé |
Anterior lumbar interbody spinal fusion (ALIF) is performed for various conditions, including spondylolisthesis, symptomatic degenerative disc disease, and as a salvage for failed posterior spinal fusion.2 As early as 1923, surgeons were performing anterior lumbar discectomies for tuberculous spondylitis through a midline laparotomy incision.12 Attempts to fuse the spine with tibial bone grafts were successful in many cases. In 1931, Carpener4 described the technique of anterior, transabdominal lumbar spinal fusion for spondylolisthesis through a long oblique incision from the 12th rib posteriorly to the lower midline abdomen anteriorly.3, 4 This approach was an extension of the flank incision general surgeons had been using for lumbar sympathectomies.31 Freebody et al9 popularized ALIF for degenerative spine conditions in 1963, and over the next 4 decades, several anterior transperitoneal and retroperitoneal approaches to the lumbosacral spine were described.5, 9, 10, 14 The least invasive method is a muscle splitting, extraperitoneal approach through a vertical or oblique 4-cm to 6-cm left lower quadrant incision.8, 20 This approach provides adequate exposure of the lumbosacral intervertebral discs but is restrictive when mobilizing deeper structures, such as the major abdominal and pelvic vessels and sympathetic plexus. Modifications in these techniques, such as the use of crossed Steinmann pins and newer retractor systems to hold and protect the great vessels and abdominal organs, have greatly enhanced the open procedure.23
Interest in applying minimally invasive techniques to ALIF began in 1991.25 Over the next several years, a laparoscopic technique for ALIF was developed.11, 19, 33 The role of the general surgeon in the surgical management of spinal disorders dramatically increased in response to the need for a skilled laparoscopist to collaborate with spine surgeons to perform laparoscopic ALIF.29
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| Address reprint requests to B. Todd Heniford, MD, Chief of Minimal Access Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Medical Education Building 601, Charlotte, NC 28203 |
Vol 80 - N° 5
P. 1487-1500 - octobre 2000 Retour au numéro
Article précédent
- LAPAROSCOPY IN UROLOGY
- Sean P. Hedican
- THORACOSCOPIC ESOPHAGOMYOTOMY FOR ACHALASIA
- James W. Maher
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