MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

Javier Quillo-Olvera,Ramses Uriel Ortiz-Leyva,Manuel Rodríguez-García,Carlos Francisco Gutiérrez-Partida,José Antonio Soriano-Sánchez,Sergio Soriano-Solis

doi:10.1590/s1808-185120151404152838

Abstract

Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

Highlights

In 1982, Harms and Rolinger suggested placing bone graft and titanium mesh in the intersomatic space, with distraction using prior transpedicular instrumentation through the direct transforaminal route; this approach could be completed by exposing the ipsilateral foramen, with minimal retraction of the thecal sac
Invasive transforaminal lumbar interbody fusion (TLIF) (MI-TLIF) was described for the first time by Foley et al, in 2003.4 This approach is less traumatic; it has more rapid recovery compared with conventional open TLIF, and the more lateral exposure of the intersomatic space allows less manipulation of neural elements, preserves the posterior tension band, and reduces injury to the paraspinal muscles.[1,2,5,6]
We compared these with diagrams and anatomical models in order to show the microsurgical landmarks used by the Senior author (JASS) for access to the lumbar interbody space through the foramen during the Minimally invasive TLIF (MI-TLIF) technique

Summary

Introduction

In 1982, Harms and Rolinger suggested placing bone graft and titanium mesh in the intersomatic space, with distraction using prior transpedicular instrumentation through the direct transforaminal route; this approach could be completed by exposing the ipsilateral foramen, with minimal retraction of the thecal sac. The aim of this work was to define the most relevant microanatomical landmarks of microsurgical target in the MI-TLIF; facet joint complex

Objectives

Methods

Conclusion