A new “keyhole” approach for multilevel anterior lumbar interbody fusion: the perinavel approach—technical note and literature review

Bassani, Roberto; Querenghi, Amos M.; Cecchinato, Riccardo; Morselli, Carlotta; Casero, Giovanni; Gavino, D; Brock, Stefano; Ferlinghetti, C.

doi:10.1007/s00586-018-5659-0

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…Although the size of the incision is smaller than that of conventional ALIF, there is a possibility that wound healing may be affected by blood vessel damage and supply, as most blood suppliers in the abdomen are vertically distributed. Recently, Bassani et al 11 introduced the "keyhole approach" using a perinavel incision, which creates a rounded incision under the navel to create a skin lid and is then closed again postoperatively. This type of incision reduces postoperative scars more than the conventional "mini-open approach. "…”

Section: Discussionmentioning

confidence: 99%

Transumbilical Retroperitoneal Lumbar Interbody Fusion: A Technical Note and Preliminary Case Series

et al. 2021

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Objective: Anterior lumbar interbody fusion (ALIF) has advantages over posterior lumbar interbody fusion or transforaminal lumbar interbody fusion techniques in that it minimizes damage to the anatomical structure of the posterior spinal segment and enables indirect decompression of the foramen by insertion of a tall cage. However, the predominant abdominal scar tissue reduces patients' satisfaction after ALIF. Herein, we describe the technique of transumbilical lumbar interbody fusion (TULIF) and its preliminary results in a case series. Methods: A retrospective review of 154 consecutive patients who underwent TULIF between the L2-3 and L4-5 levels was performed. After preoperatively selecting patients by evaluating the location of the umbilicus and vessel anatomy, a vertical skin incision was made on the umbilicus to minimize the abdominal scar tissue. Results: There were 120 single-level (110 L4-5 and 10 L3-4), 31 two-level, and 3 three-level surgeries. All patients were very satisfied with their postoperative abdominal scars, which were noticeably faint compared to those after conventional ALIF. Conclusion: TULIF is a feasible, minimally invasive surgical option that can achieve both the treatment of degenerative spinal disease and satisfactory cosmesis. Although it is technically demanding, patients obtain sufficient benefits.

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Section: Discussionmentioning

confidence: 99%

Transumbilical Retroperitoneal Lumbar Interbody Fusion: A Technical Note and Preliminary Case Series

et al. 2021

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“…Our preliminary experience is based on a linear horizontal skin incision of 6 to 8 cm in length, 5 to 7 cm beneath the umbilicus, thus allowing a wider and easier exposure of abdominal structures. Bassani et al 17 proposed a very minimally invasive skin incision, ''semilunar'' shaped in the inferior aspect of the umbilicus; this technique was applied in a large series of patients with optimal aesthetical results.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors proposed the employ of endoscopic-assisted visualization to overcome these difficulties. 17 However, endoscopic view is characterized by the lack of 3D visualization unless the use of 3D endoscope, poor image quality compared with the operating microscope, and the frequent loss of visualization due to opacity related to evaporation or in case of significant intraoperative bleeding. Moreover, the endoscope needs to be held by one of the surgeons, thus subtracting ''hands'' for surgical maneuvers.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of a High Definition Three-Dimensional Exoscope in Anterior Lumbar Interbody Fusion: Technical Note

D’Ercole

Serchi

Zanello³

et al. 2020

Int J Spine Surg

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Objectives: Video-assisted telescope operating monitor (VITOM) or exoscope is currently applied in different surgical specialties with clear visualization advantages in terms of magnification, illumination, and wide field of view. The small and deep surgical field of anterior lumbar interbody fusion (ALIF) seemed to be an ideal setting to assess efficacy of exoscope, also considering limits related to microscopic and endoscopic visualization currently employed.Methods: We reported our preliminary experience with exoscope in 9 cases of ALIF at L5-S1 level. These data were retrospectively compared with those obtained from an equal sample of ALIF procedures performed with endoscope as visualization instrument. The technical aspects taken into account were time for procedure and blood loss. Reports from the surgeon about ergonomics and confidence with both techniques were also evaluated.Results: Exoscope proved, in our experience, good visualization and ergonomics and unobstructed access to a small and deep surgical field, allowing abundant space to insert and manipulate the instruments.Conclusions: The instrument contained dimension and its long working distance, superior to endoscope and comparable with operating microscope, showed clear advantages of maneuverability. Moreover, the stereoscopic vision provided by 3-dimensional images proved to be crucial in hand-eye coordination.

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“…These operations are performed with the patient in the supine Trendelenburg position, using a paraumbilical incision, and then the promontory of the sacrum and the L5-S1 disc space is exposed by gently dissecting the retroperitoneal space, carefully mobilizing the retroperitoneal vessels. 34,35 These techniques have some limits that need to be discussed: there are anatomical limitations in obese patients; iliac veins might be retracted and potentially injured; and in case a posterior instrumentation is needed, the patient must be flipped for a second stage. 21 A systematic review by Bateman et al reported that the most common complications of ALIF were venous injury (3.2%), retrograde ejaculation (2.7%), and neurological injury (2%).…”

Section: Discussionmentioning

confidence: 99%

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

Miscusi

Trungu

Ricciardi

et al. 2020

Neurosurgical Focus

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OBJECTIVEOver the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5–S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5–S1 segment in a single cohort of patients.METHODSThis is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5–S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively.RESULTSThirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44–75 years). The mean follow-up was 33.1 months (range 13–48 months). The mean pre- and postoperative visual analog scale (7.9 ± 1.3 vs 2.4 ± 0.8, p < 0.05), Oswestry Disability Index (52.8 ± 14.4 vs 22.9 ± 6.0, p < 0.05), and SF-36 (37.3 ± 5.8 vs 69.8 ± 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5–S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence–lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis.CONCLUSIONSIn the present case series, ATP fusion for the L5–S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5–S1 conditions.

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A new “keyhole” approach for multilevel anterior lumbar interbody fusion: the perinavel approach—technical note and literature review

Cited by 17 publications

References 18 publications

Transumbilical Retroperitoneal Lumbar Interbody Fusion: A Technical Note and Preliminary Case Series

Transumbilical Retroperitoneal Lumbar Interbody Fusion: A Technical Note and Preliminary Case Series

Clinical Application of a High Definition Three-Dimensional Exoscope in Anterior Lumbar Interbody Fusion: Technical Note

The anterior-to-psoas approach for interbody fusion at the L5–S1 segment: clinical and radiological outcomes

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