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

Abstract

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.

Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study

“…1,2 Traditionally, many kinds of lumbar interbody fusions have been conducted, such as posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and direct lumbar interbody fusion using different approaches and fusion materials. [2][3][4][5][6][7][8][9] In recent years, TLIF can be performed via a minimally invasive surgical (MIS) approach, which can reduce the denervation of multifidus muscle as well as reduce the incidence of intramuscular degeneration and necrosis. 4,[6][7][8] However, patients undergoing MIS-TLIF often suffer from chronic back pain after surgery, owing to the resection of paravertebral muscles and facet joints.…”

Commentary on “Perioperative Clinical Features and Long-term Prognosis After Oblique Lateral Interbody Fusion (OLIF), OLIF With Anterolateral Screw Fixation, or OLIF With Percutaneous Pedicle Fixation: A Comprehensive Treatment Strategy for Patients With Lumbar Degenerative Disease”

“…In addition, Bae et al [ 9 ] reported that using the method using transumbilical retroperitoneal lumbar interbody fusion, although technically difficult, both the treatment of degenerative spinal diseases and satisfactory cosmetic results could be achieved.…”