Transperitoneal Approach to the Intervertebral Disc in THE.LUMBAR Area

Abstract

THE SYNDROME OF LOW BACK PAIN, with various sciatic nerve symptoms, is now a well recognized entity and constitutes one of the major groups of chronic disabling conditions occurring in individuals during t'he most productive years of life. One of the etiologic conditions has now been scientifically established; that it is no longer a hypothesis has been demonstrated by sound research work in the past IO years. Statistics indicate that alterations in the structure and contour of the intervertebral disc at the 4th and 5th lumbar spaces are responsible for a large percentage of disabling conditions in the low back. Although the etiology and pathology are well recognized, the treatment remains a very controversial subject. The basis of this is the lack of uniformly good results.The purpose of this publication is to present a technic fashioned to improve upon some of the previously known principles thought to be prime factors in obtaining good results in the treatment of degenerative changes in intervertebral discs. It is not intended in this presentation to offer any contributions or criticisms of present methods of diagnosis or other clinical relations, except in so far as they may be connected with the present surgical technic described.Poppen' in a review of 400 postoperative disc cases noted perfect results in only 38 per cent, the remainder having varying degrees of disability classed as undesirable. Kirstein2 reports 72 per cent of his operated cases as free from "sciatica," 48 per cent completely free from local back symptoms, and only 24 per cent as symptom-free. DeBakey reports on 2,450 cases of ruptured intervertebral discs in the U. S. Army to the date of August, I944. Analysis of these cases reveals that 75 per cent of the group were treated without surgery; 78 per cent of this conservatively treated group were discharged because of this condition. Of the group that received surgery, 3I per cent were discharged during the first year after surgery. In a previous article published by one

In vitro comparison of endplate preparation between four mini-open interbody fusion approaches

“…Lumbar interbody fusion was first described for the treatment of degenerative disc disease via the anterior (ALIF) approach [9]. ALIF, while allowing for extensive access to the disc space for preparation at the lower lumbar levels, can be associated with vascular, visceral, and reproductive risks [10,11].…”

A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results

“…Anterior lumbar interbody fusion has been an established surgical treatment for degenerative low back pain since its first description by Lane and Moore [18]. Simultaneous combined anterior and posterior fusion was first carried out by O'Brien in 1960 [26].…”

Surgical Interbody Research Group–radiographic assessment of interbody fusion devices: fusion criteria for anterior lumbar interbody surgery

“…A wide range of fusion rates for the procedure has been reported (unpublished data, Burkus and associates). 2,6,9,12,13,16,18,20,22 The variability in fusion rates is, in part, determined by patient selection and surgical technique and also by the investigator's definition of fusion. No uniform methods or criteria for determining fusion after lumbar interbody fusion have been established.…”