Minimally invasive spine surgery has evolved from traditional open spine surgery, and it is an accepted, safe alternative (McAfee, et al., 2010). Traditional open operations for lumbar interbody fusion include anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF).
The ALIF provides for a large interbody graft for disc space re-expansion, restoration of lumbar lordosis, and elimination of discogenic pain (Hodgson & Stock, 1956). In addition, posterior facet joint complexes and tension bands remain intact. However, an access surgeon may be needed, and complications can include a risk of vascular injury and also rare iatrogenic retrograde ejaculation in males postoperatively.
The TLIF (Harms & Rolinger, 1982; Harms & Jeszenszky, 1998) was developed as a modification of the PLIF (Cloward, 1953) to decrease the degree of nerve root and thecal sac manipulation, and it allows for interbody fusion, concurrent posterior segmental instrumentation, and circumferential fusion. It can be performed either in an open or minimally invasive manner. The graft size is typically smaller than that of the ALIF, however.
LATERAL
First introduced by Luiz Pimenta in 2001, the retroperitoneal transpsoas minimally invasive
lateral interbody fusion (MIS LIF) or Lateral Lumbar Interbody Fusion (LLIF) is a safe and effective alternative to anterior or posterior approaches for lumbar fusion (Pimenta, 2001; Ozgur, et al., 2006). Advantages include indirectneurological decompression with less tissue trauma, minimal blood loss, shorter operation times, less wound issues, placement of a larger cage, and early patient mobilization (Eck, et al.,2007; Benglis, et al., 2008; Wang, et al., 2008; Uribe, et al., 2010). In addition, normal stabilizing ligaments are not sacrificed as compared to other interbody techniques.
This technique was an adaptation of an endoscopic lateral transpsoas approach to lumbar fusion as described by Bergey et al. (Bergey, et al., 2004). They found that the endoscopic lateral transpsoas approach to the lumbar spine was a safe method to fuse the lumbar vertebrae, which allowed for exposure of the lumbar spine without mobilization of the great vessels or sympathetic plexus.
Today, there are several systems from various manufacturers that will allow for an MIS
lateral retroperitoneal transpsoas approach. The two most common are the eXtreme Lateral
Interbody Fusion/XLIF® (NuVasive, San Diego, CA) and Direct Lateral Interbody
Fusion/DLIF® (Medtronic, Memphis, TN).Clinical applications of the retroperitoneal transpsoas MIS LIF include a wide range of spinal conditions including trauma, adult degenerative scoliosis, degenerative disc disease,spondylosis with instability, lumbar stenosis, spondylolisthesis, tumor, and adjacentsegment failure. Research on MIS LIF is very active, and clinical outcomes appear to be
promising.
Source:Tien V. Le and Juan S. Uribe (2012). The Minimally Invasive Retroperitoneal Transpsoas Approach, Spine Surgery, Dr. Kook Jin Chung (Ed.), ISBN: 978-953-51-0469-8