What's new in spinal surgery?

Abstract

Fusion is now being performed such that the damage to surrounding tissues is minimized to maximize function around the fused segment. It is now possible to perform fusion to the anterior and posterior lumbar spine through minimally invasive approaches. Anterior fusion from the L4/5 disc space up into the thoracic spine via a retroperitoneal transpsoas approach can be performed with the patient in the lateral position using the Extreme Far Lateral Approach (XLIF, NuVasive, San Diego, USA). However, passing through the psoas is only possible because targeted motor monitoring is now available to prevent damage to the lumbar plexus. This technique is being used for stand alone fusions, spondylolisthesis and degenerate scoliosis. Previously more extensive surgery and different approaches meant that many patients were not fit enough to undergo fusion. The L5/S1 space can be fused anteriorly using the Transaxial ALIF approach (AXIALIF). This is a minimally invasive approach that is performed by passing instruments and a screw across the disc space via the presacral space behind the rectum. Both of these procedures can be supplemented with percutaneous posterior fixation using pedicle screws through tubes away from the midline. There is also continued interest in Posterior Lumbar Interbody Fusion and Trans Foraminal Interbody Fusion as ways of providing anterior fusion from a posterior approach; these are also becoming less invasive and destructive procedures. Total disc arthroplasty