変性腰椎すべり症および側弯症に対するmini-ALIFによる治療戦略

抄録

  For the spine, anterior column support is more important than posterior column support. Two-thirds of the spinal support force is derived from the anterior column. Destruction of the anterior support, which is most frequently due to disc degeneration, can cause a variety of degenerative disorders of the lumbar spine.

  Mini-ALIF, or minimally invasive anterior lumbar interbody fusion, is a surgical method used to treat the spine. The technique of this surgery is as follows.

  1) Under general anesthesia, the patient is placed in the right lateral position.

  2) A skin incision is made in the supra-iliac crest area.

  3) The psoas major muscle is accessed retroperitoneally.

  4) The desired disc is accessed by retracting the psoas major muscle and the disc level is confirmed through fluoroscopy.

  5) A discectomy is performed until the posterior ligament can be seen.

  6) A distractor is inserted into the disc space and rotated 90°to regain the appropriate disc. height and the correct alignment that have been lost because of scoliosis or spondylolisthesis.

  7) Two artificial discs are inserted into the disc level.

  The patient is allowed to walk the day after surgery. The average hospital stay is 10 days.

  Approximately 6 months after surgery, bony fusion is confirmed by performing dynamic radiography and computed tomographic scanning.