Christoph Mehren1,2, Lorenz Wanke-Jellinek3,4, Alexander Krenauer3,4, Andreas Korge3,4. 1. Wirbelsäulenzentrum, Schön Klinik, München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland. CMehren@schoen-klinik.de. 2. Akademisches Lehrkrankenhaus, Paracelsus Universität Salzburg, Salzburg, Österreich. CMehren@schoen-klinik.de. 3. Wirbelsäulenzentrum, Schön Klinik, München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland. 4. Akademisches Lehrkrankenhaus, Paracelsus Universität Salzburg, Salzburg, Österreich.
Abstract
OBJECTIVE: Minimally invasive anterolateral approach to the lumbar spine (oblique lateral interbody fusion, OLIF) to correct lumbar deformities. INDICATIONS: Ventral release in degenerative lumbar scoliosis or segmental kyphosis and intervertebral spondylodesis. CONTRAINDICATIONS: No absolute contraindications. Relative contraindications are previous (left-sided) retroperitoneal interventions or status after peritonitis with pronounced retroperitoneal scarring. Vascular anomalies with extremely lateral common iliac vein (especially with segmentation disorders in the penultimate mobile segment). SURGICAL TECHNIQUE: Through a small skin incision in the left abdominal wall and alternating incision technique through the abdominal wall muscles retroperitoneal approach to the lateral anterior lumbar spine monosegmental or from L1-L5 multisegmental if needed. Retraction of the psoas muscle and removal of the intervertebral disc space, if necessary with resection of the anterior longitudinal ligament. Intervertebral release and interposition of an implant for ventral spondylodesis. POSTOPERATIVE MANAGEMENT: Early mobilisation after dorsal instrumentation under thrombosis prophylaxis. Light meals until the first bowel movement. Wearing a trunk stabilizing brace for up to 12 weeks, depending on the type and extent of the procedure. No limitations regarding walking distance, standing and sitting immediately postoperatively. RESULTS: In all, 15 patients with degenerative lumbar scoliosis were treated with ventrodorsal fusion surgery. The surgical anterior treatment included 1-4 segments. The access-specific complications and pre- and postoperative radiological parameters were recorded. None of the 15 left-sided retroperitoneal ventral accesses showed intraoperative or postoperative access-specific complications. A significant reduction of the anteroposterior Cobb angle from 16° ± 6° preoperatively to 3° ± 2° postoperatively (p < 0.001) was achieved in the entire patient population.
OBJECTIVE: Minimally invasive anterolateral approach to the lumbar spine (oblique lateral interbody fusion, OLIF) to correct lumbar deformities. INDICATIONS: Ventral release in degenerative lumbar scoliosis or segmental kyphosis and intervertebral spondylodesis. CONTRAINDICATIONS: No absolute contraindications. Relative contraindications are previous (left-sided) retroperitoneal interventions or status after peritonitis with pronounced retroperitoneal scarring. Vascular anomalies with extremely lateral common iliac vein (especially with segmentation disorders in the penultimate mobile segment). SURGICAL TECHNIQUE: Through a small skin incision in the left abdominal wall and alternating incision technique through the abdominal wall muscles retroperitoneal approach to the lateral anterior lumbar spine monosegmental or from L1-L5 multisegmental if needed. Retraction of the psoas muscle and removal of the intervertebral disc space, if necessary with resection of the anterior longitudinal ligament. Intervertebral release and interposition of an implant for ventral spondylodesis. POSTOPERATIVE MANAGEMENT: Early mobilisation after dorsal instrumentation under thrombosis prophylaxis. Light meals until the first bowel movement. Wearing a trunk stabilizing brace for up to 12 weeks, depending on the type and extent of the procedure. No limitations regarding walking distance, standing and sitting immediately postoperatively. RESULTS: In all, 15 patients with degenerative lumbar scoliosis were treated with ventrodorsal fusion surgery. The surgical anterior treatment included 1-4 segments. The access-specific complications and pre- and postoperative radiological parameters were recorded. None of the 15 left-sided retroperitoneal ventral accesses showed intraoperative or postoperative access-specific complications. A significant reduction of the anteroposterior Cobb angle from 16° ± 6° preoperatively to 3° ± 2° postoperatively (p < 0.001) was achieved in the entire patient population.