腰椎间融合技术和比ppt课件.ppt

Lumbarinterbodyfusion:Techniquesandcomparison,1,Introduction,Lumbarinterbodyfusion(LIF)：placementofanimplant(cage,spacerorstructuralgraft)withintheintervertebralspaceafterdiscectomyandendplatepreparation.FivemainapproachesInterbodyfusion：lowerratesofpostoperativecomplicationsandpseudoarthrosis,2,TechniquereviewPLIF,OneoftheoriginalapproachesInitialdescriptionofthePLIFtechniquebyBriggsandMilliganin1944,3,PLIF,PLIF,4,Techniquereview,5,Techniquereview,6,TechniquereviewTLIF,Openingtheneuralforamenononesideonly.HarmsandRolingerreportedin1982Direct,unilateralaccesstotheintervertebralforaminalspacewhilstreducingdirectdissectionandduraltears.,7,TLIF,TLIF,8,PreservesligamentousstructureswhichareinstrumentaltorestoringbiomechanicalstabilityofthesegmentandadjacentstructuresAsingleunilateralincisionisabletoprovidebilateralanteriorcolumnsupport,9,10,TechniquereviewALIF,AnterioraccesscorridorsforlumbarfusionhavebeenusedanddevelopedsincetheywereintroducedbyCarpenterin1932.Theanteriorretroperitonealapproachtotheventralsurfaceoftheexposeddisc,allowingcomprehensivediscectomyanddirectimplantinsertion.SuitableforlevelsL4/L5andL5/S1,11,ALIF,ALIF,12,13,14,15,Disadvantages,Retrogradeejaculationvisceralandvascularinjury,16,TechniquereviewLLIF,DescribedbyOzguretal.in2006SuitableforT12toL5.ThistechniqueisnotsuitablefortheL5/S1level.NeuromonitoringisessentialSuitableforalldegenerativeindications.Especiallyforsagittalandcoronaldeformitycorrection,lumbardegenerativescoliosiswithlaterolisthesis.Notbesuitableforseverecentralcanalstenosis,bonylateralrecessstenosisandhigh-gradespondylolisthesisNotbesuitableforpriorretroperitonealsurgeryorwithretroperitonealabscess,aswellaspatientswithabnormalvascularanatomy.,17,LLIF,18,Advantage:MISmuscle-splittingapproachthatcanbeperformedwithrapidpostoperativemobilization.Aggressivedeformitycorrectioncanbeachievedwithhighfusionratesandcomprehensivediscspaceclearance.Disadvantages:Potentialrisksoflumbarplexus,psoasmuscleandbowelinjury,particularlyattheL4/5level.Vascularinjury,ifitoccurs,maybedifficulttocontrol.,19,TechniquereviewOLIF,FirstdescribedbyMichaelMayerin1997andinvolvesanMISaccesstothediscspaceviaacorridorbetweentheperitoneumandpsoasmuscleThephrase“obliquelumbarinterbodyfusion”orOLIFwasfirstcoinedbySilvestrein2012SimilarlytoanLLIFapproach,OLIFdoesnotrequireposteriorsurgery,laminectomy,facetectomyorstrippingofspinalorparaspinalmusculature.OLIFtechniquedoesnotdissectortraversethepsoasmuscleandneuromonitoringisnotnecessary.OLIFtechniqueissuitableforlevelsL1-S1.IndicationsandcontraindicationsaresimilartoLLIF,20,OLIF,OLIF,21,Advantage:LLIF+lessriskoflumbarplexusandpsoasmuscledamage.Disadvantages:Potentialrisksofincludesympatheticdysfunctionandvascularinjury,22,SilvestreC,Mac-ThiongJM,HilmiR,etal.Complicationsandmorbiditiesofmini-openante