Laparoscopic Anterior Lumbar Interbody Fusion at L4–L5

Kleeman, Thomas J.; Ahn, Uri M.; Clutterbuck, William B.; Campbell, Connie J.; Talbot-Kleeman, Anne

doi:10.1097/00007632-200207010-00004

Cited by 44 publications

(4 citation statements)

References 24 publications

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“…[ 11 ] Laparoscopic ALIF is not suitable for wide use because of its complex operation, many procedures, limited field of vision and long learning curve. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Imaging Anatomical Research on the Operative Windows of Oblique Lumbar Interbody Fusion

et al. 2016

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To provide applied anatomical evidence of the preoperative assessment of oblique lumbar interbody fusion (OLIF), the anatomical parameters of the OLIF operative window were observed through computed tomography angiography (CTA). We selected imaging data from 60 adults (30 males, 30 females) who underwent abdominal CTA and T12-S1 vertebral computed tomography (CT) with three-dimensional reconstruction. The OLIF operative windows at the L1-2, L2-3, L3-4, L4-5 and L5-S1 levels were as follows: the vascular window, bare window, psoas major window, ideal operative window, and actual operative window. Each level's actual operative window was statistically analyzed based on an actual operative window of <1 cm and ≥1 cm. The vascular window was largest at L4-5 (1.72 ± 0.58 cm). The bare window was largest at L5-S1 (1.59 ± 0.93 cm) and smallest at L3-4 (1.37 ± 0.51 cm). The psoas major window was largest at L3-4 (1.14 ± 0.35 cm) and smallest at L1-2 (0.41 ± 0.34 cm). The ideal operative window was largest at L4-5 (3.74 ± 0.36 cm) and smallest at L1-2 (3.23 ± 0.30 cm). The actual operative window was largest at L3-4, followed by L2-3, L4-5, L1-2, and L5-S1, which were 2.51 ± 0.56 cm, 2.28 ± 0.54 cm, 2.01 ± 0.74 cm, 1.80 ± 0.45 cm and 1.59 ± 0.93 cm, respectively (P = 0.000), and the percentages of the actual surgical window were 69%, 66%, 53%, 56% and 43%, respectively. The actual surgical window was <1 cm in 2 cases at L1-2 (3.3%), 4 cases at L4-5 (6.7%), and 17 cases at L5-S1 (28.3%) (11 males and 6 females). The regional anatomy of each level related to OLIF has its own peculiarities, and not all levels are suitable for OLIF. Before OLIF surgery, surgeons should analyze the imaging anatomy and select the appropriate surgical procedures.

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“…[ 11 ] Laparoscopic ALIF is not suitable for wide use because of its complex operation, many procedures, limited field of vision and long learning curve. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Imaging Anatomical Research on the Operative Windows of Oblique Lumbar Interbody Fusion

et al. 2016

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“…Nalbandian et al examined the detailed anatomy of ILV in 159 cases of anterior lumbar open surgeries, and only 1.3% were missing the LIV [6]. As the LIV systems were difficult to visualize clearly on either MRI or enhanced CT [6,13], our detection rate of 52% on MRI was relatively reasonable. In our evaluation, type 1 and type 2 were detected in 40% and 12%, respectively (Figure 5).…”

Section: Discussionmentioning

confidence: 68%

Comparative Analysis of Vascular Structures in OLIF51 and the Lateral Corridor Approach under Supine MRI and Intraoperative Enhanced CT in the Lateral Decubitus Position

Kotani,

Tachi,

Ikeura

et al. 2024

Medicina

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Background and objectives: As the oblique lateral interbody fusion at L5/S1 (OLIF51) and the lateral corridor approach (LCA) have gained popularity, an understanding of the precise vascular structure at the L5/S1 level is indispensable. The objectives of this study were to investigate the vascular anatomy at the L5/S1 level, and to compare the movement of vascular tissue between the supine and lateral decubitus positions using intraoperative enhanced CT and MRI. Materials and Methods: A total of 43 patients who underwent either OLIF51 or LCA were investigated with an average age at surgery of 60.4 (37–80) years old. The preoperative MRI was taken to observe the axial and sagittal anatomy of the vascular position under the supine position. The intraoperative vein-enhanced CT was taken just before incision in the right decubitus position, and compared to supine MRI anatomy. Iliolumbar vein appearance and its types were also classified. Results: The average vascular window allowed for OLIF51 was 22.8 mm and 34.1 mm at either the L5 caudal endplate level or the S1 cephalad endplate level, respectively. The LCA was 14.2 mm and 12.6 mm at either level, respectively. The left common iliac vein moved 3.8 mm and 6.9 mm to the right direction at either level from supine to the right decubitus position, respectively. The bifurcation moved 6.3 mm to the caudal direction from supine to right decubitus. The iliolumbar vein was located at 31 mm laterally from the midline, and the MRI detection rate was 52%. Conclusions: The precise measurement of vascular anatomy indicated that the OLIF51 approach was the standard minimally invasive anterior approach for the L5/S1 disc level compared to LCA; however, there were many variations in quantitative anatomy as well as significant vascular movements between the supine and right decubitus positions. In the clinical setting of OLIF51 and LCA surgeries, careful preoperative evaluation and intraoperative 3D imaging are recommended for safe and accurate surgery.

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“…No patient had a previous history of an anterior lumbar procedure. Before surgery, computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) was performed to define the prevertebral vascular anatomy before the anterior lumbosacral procedure [ 12 , 13 ]. No occlusion, stenosis, atherosclerosis or other vascular pathology was detected at the lumbosacral spinal region.…”

Section: Methodsmentioning

confidence: 99%

Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel

Zhang

et al. 2016

BMC Musculoskelet Disord

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BackgroundThere has been no consensus regarding what is the optimal means of treating lumbosacral segment tuberculosis. The aim of this study was to evaluate the clinical outcomes of our newly developed one-stage anterior debridement and fusion combined with dual screw-rod construct anterior instrument underneath the iliac vessels for lumbosacral spinal tuberculosis.MethodsWe retrospectively reviewed 22 patients with lumbosacral spinal tuberculosis who underwent one-stage anterior debridement and fusion combined with dual screw-rod anterior instrument underneath the iliac vessels between January 2004 and June 2013. We assessed the visual analogue scale (VAS), erythrocyte sedimentation rates (ESR), neurological performance, kyphotic angles, fusion rates, and computed tomographic angiography (CTA) before and after surgery.ResultsAll patients were followed-up for a mean of 46.59 months. There were no instances of spinal tuberculosis recurrence. The mean VAS scores and ESR decreased significantly from the preoperative levels both postoperatively and at the final follow-up (all P <0.001). The mean kyphotic angle significantly increased from the mean preoperative angle both postoperatively and at the final follow-up (both P <0.001). All patients had bone fusion at a mean of five months after surgery. No postoperative vascular complications were observed.ConclusionsOur findings suggest that anterior radical debridement, fusion combined with dual screw-rod anterior instrument underneath the iliac vessels can be an effective and safe treatment option for lumbosacral segment tuberculosis.

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Laparoscopic Anterior Lumbar Interbody Fusion at L4–L5

Cited by 44 publications

References 24 publications

Imaging Anatomical Research on the Operative Windows of Oblique Lumbar Interbody Fusion

Imaging Anatomical Research on the Operative Windows of Oblique Lumbar Interbody Fusion

Comparative Analysis of Vascular Structures in OLIF51 and the Lateral Corridor Approach under Supine MRI and Intraoperative Enhanced CT in the Lateral Decubitus Position

Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel

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