一年級語文下冊識字一2姓氏歌教學(xué)課件部編版

Lumbarinterbodyfusion:Techniques

andcomparison

1Lumbarinterbodyfusion:TechnIntroductionLumbarinterbodyfusion(LIF)：placementofanimplant(cage,spacerorstructural

graft)withintheintervertebralspaceafterdiscectomyand

endplatepreparation.FivemainapproachesInterbodyfusion：lowerratesofpostoperativecomplicationsand

pseudoarthrosis2IntroductionLumbarinterbodyfTechniquereview

PLIFOneoftheoriginalapproachesInitialdescriptionofthePLIFtechniqueby

BriggsandMilliganin19443TechniquereviewPLIFOneofthPLIFPLIF4PLIFPLIF4Techniquereview5Techniquereview5Techniquereview6Techniquereview6Techniquereview

TLIFOpeningtheneural

foramenononesideonly.Harms

andRolingerreportedin1982Direct,unilateral

accesstotheintervertebralforaminalspacewhilst

reducingdirectdissection

and

dural

tears.7TechniquereviewTLIF7TLIFTLIF8TLIFTLIF8Preserves

ligamentousstructureswhichareinstrumentaltorestoring

biomechanicalstabilityofthesegmentandadjacent

structuresAsingleunilateralincision

isabletoprovidebilateralanteriorcolumnsupport9Preservesligamentousstructur1010Techniquereview

ALIFAnterioraccesscorridorsforlumbarfusionhavebeenusedand

developedsincetheywereintroducedbyCarpenterin1932.Theanteriorretroperitonealapproachtothe

ventralsurfaceoftheexposed

disc,allowingcomprehensivediscectomyanddirectimplant

insertion.Suitable

forlevelsL4/L5andL5/S111TechniquereviewALIF11ALIFALIF12ALIFALIF12131314141515Disadvantages

Retrograde

ejaculationvisceralandvascularinjury16Disadvantages

RetrogradeejaTechniquereview

LLIFDescribedbyOzguretal.in2006SuitableforT12to

L5.ThistechniqueisnotsuitablefortheL5/S1level.NeuromonitoringisessentialSuitableforalldegenerative

indications.Especially

forsagittalandcoronal

deformitycorrection,

lumbardegenerative

scoliosiswithlaterolisthesis.Notbesuitableforseverecentralcanal

stenosis,bonylateralrecessstenosisandhigh-grade

spondylolisthesisNotbesuitableforprior

retroperitonealsurgeryorwithretroperitonealabscess,as

wellaspatientswithabnormalvascularanatomy.17TechniquereviewLLIF17LLIF18LLIF18Advantage:MISmuscle-splittingapproachthatcan

beperformedwithrapidpostoperativemobilization.Aggressivedeformitycorrectioncanbeachievedwithhigh

fusionratesandcomprehensivediscspaceclearance.Disadvantages:Potentialrisksoflumbarplexus,

psoasmuscleandbowelinjury,particularlyattheL4/5

level.Vascularinjury,ifitoccurs,maybedifficultto

control.19Advantage:19Techniquereview

OLIFFirstdescribedbyMichael

Mayerin1997andinvolvesanMISaccesstothe

discspaceviaacorridorbetweentheperitoneumand

psoasmuscleThephrase“obliquelumbarinterbodyfusion”orOLIFwasfirst

coinedbySilvestrein2012SimilarlytoanLLIFapproach,

OLIFdoesnotrequireposteriorsurgery,laminectomy,

facetectomyorstrippingofspinalorparaspinalmusculature.OLIFtechniquedoesnotdissectortraversethepsoas

muscle

and

neuromonitoringisnot

necessary.OLIFtechniqueissuitable

forlevelsL1-S1.Indicationsand

contraindications

are

similartoLLIF20TechniquereviewOLIFFirstdesOLIFOLIF21OLIFOLIF21Advantage:LLIF+less

risk

of

lumbar

plexus

and

psoas

muscle

damage.Disadvantages:Potential

risksof

includesympathetic

dysfunctionandvascularinjury22Advantage:22SilvestreC,Mac-ThiongJM,HilmiR,etal.Complicationsandmorbiditiesof

mini-openanteriorretroperitoneallumbarint