Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

Summary

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

Abstract

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

Introduction

Anterior lumbar interbody fusion (ALIF), a fusion procedure that takes an abdominal approach to the anterior lumbar spine, was first described by O'Brien in 1983¹. With the advantages of less bleeding, less muscle and nerve damage, and the ability to restore lumbar lordosis and reduce the impact on adjacent segmental degeneration better than posterior lumbar interbody fusion, ALIF is now widely used to treat lumbar spondylolisthesis, spinal deformities, lumbar spine infections, and degenerative lumbar disc disease^2,3. However, the procedure can also lead to complications such as vas....

Protocol

This study was reviewed and approved by the Hebei Medical University Third Affiliated Hospital ethics committee, and written informed consent was obtained from all the patients. In addition, no images are identifiable to any patients.

1. Preoperative preparation

1. Select appropriate cases based on the patient history, including symptoms, signs, history of previous lumbar and abdominal surgery, abdominal examination, and imaging, such as lumbar X-ray, computed tomogra.......

Discussion

Several turns surrounding the peritoneum during Mini-ALIF surgical exposure and decompression of the spinal canal are critical steps in the surgery. Injury to the anterior peritoneum when opening the anterior rectus abdominis sheath and separating the transverse abdominal fascia can easily lead to failure with this approach⁵. In addition, patients with lumbar spine infections and a history of abdominal surgery can develop intraoperative complications such as adhesions of the peritoneum and soft ti.......

Materials

Name	Company	Catalog Number	Comments
Anterior Lumbar Cage Instrument	LDR Medical	ROI-A
Cefazolin Sodium for Injection	Brilliant Pharmaceuticals	Chinese Drug Approval Number H20217016
Coagulation Forceps	Zhenjiang Hengsheng Juen Medical Instrument Co., Ltd.	BZN-Q-A-S
Coated, Braided Silk	Suzhou Jiasheng Medical Treatment Products Co.,Ltd.	2-0(4#)
Endplate Rugine	LDR Medical	IGO16R
Microscope	Carl Zeiss AG	S88
SPSS Statistics for Windows	IBM Corp	version 26.0
Surgical ablation electrodes	Jiangsu Yibo Leiming Medical Technology Co., Ltd.	LM-A5