[Transmuscular approach (XLIF technique) for anterior surgery of the lumbar spine].

IF 1 4区医学 Q3 ORTHOPEDICS

Operative Orthopadie Und Traumatologie Pub Date : 2023-04-01 DOI:10.1007/s00064-023-00799-6

Gregor Schmeiser, Ralph Kothe

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引用次数: 0

Abstract

Objective: Anterior stabilization of the spine with a lateral approach to insert a large and broad cage creating a better bearing surface to restore or maintain the lumbar lordosis.

Indications: Degenerative scoliosis as well as revision surgery for stenosis of the neuroforamen. Lumbar corpectomies between L2/3 and L4/5 can be approached as well.

Contraindications: The segment L5/S1 is not suitable for the transmuscular approach. Relative contraindications are previous retroperitoneal surgery and spondylolisthesis with sliding of more than 50% (> Meyerding 2) SURGICAL TECHNIQUE: We describe the transmuscular retroperitoneal approach to the lumbar segments which is called extreme lateral approach (XLIF). To protect the spinal nerves on the way through the psoas muscle, use of intraoperative triggered neuromonitoring is paramount.

Postoperative management: Full mobilization directly after surgery is possible in most cases. Weight bearing should be restricted to 20 kg for 3 months after surgery.

Results: The transmuscular approach to the lumbar spine is a good alternative to reach the anterior part of the lumbar spine. Degenerative scoliosis as well as stenosis of the neuroforamen especially in revision surgery are good indications for this technique. Injuries of the spinal nerves range from 0.7 to 15%. Other complications are rare.

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[经肌肉入路(XLIF技术)腰椎前路手术]。

目的:通过侧入路插入大而宽的椎笼来实现脊柱前路稳定，创造更好的承载面，以恢复或维持腰椎前凸。适应症:退行性脊柱侧凸以及神经孔狭窄的翻修手术。腰椎椎体L2/3和L4/5之间也可以入路。禁忌症:L5/S1段不适合经肌入路。相对禁忌症是既往腹膜后手术和滑脱超过50%的腰椎滑脱(> Meyerding 2)手术技术:我们描述了经肌肉腹膜后入路腰椎节段，称为极端外侧入路(XLIF)。为了保护穿过腰肌的脊神经，术中使用触发神经监测是至关重要的。术后处理:在大多数情况下，术后直接完全活动是可能的。术后3个月内，体重应控制在20 公斤。结果:经肌肉入路是一种较好的腰椎前路入路。退行性脊柱侧凸以及神经孔狭窄，特别是在翻修手术中，是该技术的良好适应症。脊神经损伤的范围从0.7到15%。其他并发症很少见。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Operative Orthopadie Und Traumatologie ORTHOPEDICS-

CiteScore

2.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care. The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems. Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.