Abstract
PurposeThis study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study.MethodsThe ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers.ResultsThe use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8–9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement.ConclusionsAccording to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.
Highlights
Lumbar interbody fusion (LIF), such as posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF), is the mainstay surgical treatment for degenerative lumbar disease, lumbar instability, and intervertebral disc disorders
Conventional PLIF and TLIF are still preferred in current practice [6]
Inspired by the conception of transforaminal endoscopy, we developed a modified TLIF technique, namely extreme lateral TLIF (ELIF) [7]
Summary
Lumbar interbody fusion (LIF), such as posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF), is the mainstay surgical treatment for degenerative lumbar disease, lumbar instability, and intervertebral disc disorders. Spinal surgeons are always attempting to modify the surgical approaches to LIF in more minimal invasive ways These newly emerging modifications include anterior LIF, with a trans- or extraperitoneal approach anterior to the lumbar vertebrae [1], extreme lateral LIF, with a trans-psoas-major-muscle approach that is lateral to the lumbar vertebrae [2], and axial LIF, with a presacral approach [3]. These modified techniques are subject to some limitations including a steep learning curve, technical difficulty of manipulation, and high risk of procedural complications such as retrograde ejaculation, vascular or ureteral injury, and compromised lumbosacral plexus or genitofemoral nerve function [4,5]. ELIF facilitates the decompression of the lateral vertebral canal and the fusion of vertebral bodies in a ‘‘safety triangle.’’
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