Technique for Exposing Lumbar Discs in Anterior Approach Using Steinmann Wires: Arthroplasties or Arthrodesis

Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis

“…As the average life expectancy increases, degenerative diseases of the lumbar spine, including spondylolisthesis, disc degeneration, and spinal stenosis, have become more common worldwide [ 23 ]. Degenerative diseases of the lumbar spine can cause lower back pain, numbness, pain in the lower extremities, lameness, and even disability, all of which can negatively affect a patient’s body.…”

Acesso à coluna lombossacral: Visão atual

“…However, higher levels from L2 to S1 have already been performed by experienced surgeons. 27 The anterior access technique to the lumbosacral spine is helpful in degenerative disc disease, isthmic or degenerative spondylolisthesis, spondylodiscitis, pseudarthrosis, removal of mispositioned or migrated TLIF or PLIF cages, disease, or degeneration of the adjacent level. 28 The posterior approach has a higher risk of neurological damage and dural tear due the presence of fibrosis, with the anterior access being preferred and with less morbidity.…”

“…28 The posterior approach has a higher risk of neurological damage and dural tear due the presence of fibrosis, with the anterior access being preferred and with less morbidity. 27 Restoration of sagittal balance allows using hyper lordotic implants (up to 30 degrees) and the desired rebalancing of vertebral body injuries from fractures or tumours. Some advantages of this technique include the direct view of the midline of the disc space and the extensive lateral exposure of the vertebral bodies, which allows an efficient release of the disc space, adequate access to the entire ventral surface of the disc exposed, allowing complete discectomy, restoration of disc space, automatically reducing deformity through ligamentotaxis, leading to indirect decompression.…”

“…It allows the sparing of the spine and muscles anterolateral posterior muscles to the psoas, which can reduce postoperative pain and disability. 6,27,28 Disadvantages of the ALIF technique include approachrelated complications such as vascular injuries, retrograde ejaculation, and visceral injuries. 29,30 The ALIF technique is suitable for the L4/L5 and L5/S1 levels due to the vascular anatomy that provides a large working corridor between the iliac vessels.…”

“…The ribcage can limit access at the level of L1-L2 and the iliac crest and iliac vessels at the level of L4-L5. 27,31 The advantages are less invasive operative technique, reduced operative time, and less chance of injury to the lumbar plexus, allowing direct access to the disc. Without injury to the lamina, it leads to less damage and bleeding, lower rate of nerve injury, faster postoperative recovery, less pain, short hospital stay, and increased rates of inter somatic fusion caused by a large amount of disc removal, promoting a large area of contact with the plateaus, and suitable correction of the deformities.…”