Ventral fusion operations in the lumbar spine. Microsurgical techniques

Abstract

Due to the decreased trauma in anterior as well as posterior surgical approaches to the spine, microsurgical techniques have been used more frequently in recent years. This article describes two new microsurgical techniques to approach the anterior lumbar spine for interbody fusion as part of a posterior-anterior stabilization concept in various diseases like spondylolisthesis, degenerative instability; failed back surgery syndrome, fractures etc. The lumbar segments L 2–5 are approached through a blunt muscle-splitting retroperitoneal technique. The antero-lateral circumference of the motion segment is exposed with a frame-type retractor which is anchored in the adjacent vertebral bodies with anchoring screws. The lumbosacral junction is exposed via a mini-laparotomy using a special soft tissue spreader. Interbody fusion is described with autogeneous bone grafts. Preliminary experience with 83 patients treated between 1995 and 1996 show that peri- and postoperative morbidity is low. Clinical as well as radiological results are comparable to the standard techniques. Spectrum as well as rate of complications so far do not differ from those described in the literature for non-microsurgical approaches.