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Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages. J Neurosurg 2002 Jan;96(1 Suppl):50-5

Date

01/25/2002

Pubmed ID

11795713

DOI

10.3171/spi.2002.96.1.0050

Scopus ID

2-s2.0-0036120670 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

OBJECT: Intertransverse arthrodesis in which instrumentation is placed is associated with an excellent fusion rate; however, treatment of patients with symptomatic nonunion presents a number of difficulties. Revision posterior and traditional anterior procedures are associated with methodological problems. For example, in the latter, manipulation of the major vessels from L-2 to L-4 may be undesirable. The authors describe a method for performing retroperitoneal lumbar interbody fusion (LIF) in which a threaded cage is placed from L-2 through L-5 via a lateral trajectory, and they also detail a novel technique for implanting a cage from L-5 to S-1 via an oblique trajectory. Although they present data obtained over a 2-year period in the study of 15 patients, the focus of this report is primarily on describing the surgical procedure.

METHODS: The lateral lumbar spine was exposed via a standard retroperitoneal approach. Using the anterior longitudinal ligament as a landmark, the L2-3 through L4-5 levels were fitted with instrumentation via a true lateral trajectory; the L5-S1 level was fitted with instrumentation via an oblique trajectory. A single cage was placed at each instrumented level. Fifteen symptomatic patients in whom previous lumbar fusion had failed underwent retroperitoneal LIF. Thirty-eight levels were fitted with instrumentation. There have been no instrumentation-related failures, and fusion has occurred at 37 levels during the 2-year postoperative period.

CONCLUSIONS: The use of retroperitoneal LIF in which threaded fusion cages are used avoids the technical difficulties associated with repeated posterior procedures. In addition, it allows L2-S1 instrumentation to be placed anteriorly via a single surgical approach. This construct has been shown to be biomechanically sound in animal models, and it appears to be a useful alternative for the management of failed multilevel intertransverse arthrodesis.

Author List

Wolfla CE, Maiman DJ, Coufal FJ, Wallace JR

Author

Christopher E. Wolfla MD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Equipment Design
Female
Follow-Up Studies
Humans
Lumbar Vertebrae
Male
Middle Aged
Postoperative Complications
Reoperation
Retroperitoneal Space
Sacrum
Spinal Fusion
Titanium
Tomography, X-Ray Computed