Seminars in Spine Surgery最新文献

Adult spinal deformity is a debilitating disease affecting multiple aspects of patients’ lives including mental and physical well-being and functional ability. Advances in our understanding of the deformities and operative techniques have led to large improvements in patient reported outcomes, even with the associated high rate of complications. As we transition into the era of value-based care, the relatively high cost of deformity surgery has come under increasing scrutiny. Additional investigation of the costs of deformity surgery are required in order to employ effective cost-control measures while continuing to provide high-level care.

MIS for the correction of ASD represents a continuously evolving surgical field. As the incidence of ASD continues to increase in the aging population, MIS offers an effective alternative means of surgical intervention while reducing the significant perioperative morbidity associated with traditional open techniques. MIS is not without risk; however, optimized patient selection can minimize complication risk and produce favorable clinical and radiographic outcomes. This review seeks to highlight appropriate patient selection, indications, complications, and areas in need of further investigation to evaluate long-term outcomes of these novel surgical techniques.

Adult spinal deformity surgery has been shown to be an effective treatment that improves the quality of life for symptomatic patients who have failed nonoperative management. Its prevalence has increased due to an aging patient population with longer life expectancies. Despite surgical technique advancements, it has been associated with complications that negatively impact patient outcomes. This article examines the surgical and medical complications associated with adult spinal deformity surgery and discusses their risk assessment, prevention, and management techniques.

With the avoidance of dissection through the psoas, the oblique lateral interbody fusion (OLIF) offers the spine surgeon a safe option of indirect decompression of the lumbar spine. Described in 1997, the OLIF technique continues to expand its surgical indications with the advent of navigation and robotic technology. This paper will discuss the indications and contraindications of the OLIF procedure while highlighting anatomic considerations, technical aspects, outcomes and complications. From degenerative spondylosis, to sagittal and coronal deformity, the pathology that can be addressed with the OLIF continues to evolve with the aging population. Endplate fracture and subsidence and transient neuropraxias are the most common complications, with an overall rate less than that of transforaminal lumbar interbody fusion (TLIF) or posterolateral interbody fusion (PLIF) with the added benefit of a shorter hospital stay.

Anterior lumbar interbody fusion (ALIF) is a common technique for treating a variety of lumbar spine disorders. Although used predominantly to obtain fusion, it is also excellent for restoring lumbar lordosis and can be used for indirect decompression, especially in the setting of foraminal stenosis.⁴ The technique is used predominantly at L4-5 and L5-S1, but can be used at L3-4 and even L2-3. ALIF provides an excellent biomechanical environment for arthrodesis. The anterior longitudinal ligament resection allows for excellent restoration of lordosis. ALIF can be performed as an isolated procedure or combined with posterior approaches. Although there are major risks associated with the required abdominal approach, ALIF has reached popularity for its reliability and versatility. With good knowledge of anatomical hazards, the properly indicated patient has much to gain with an ALIF surgery.

Lumbar interbody fusion has revolutionized the treatment of lumbar spinal disorders. Through restoration of disc height and interbody fusion, a surgeon has more options, particularly less invasive options, for surgical techniques. Single-position circumferential lumbar interbody fusion is becoming more common in the treatment of degenerative, oncologic, traumatic, and deformity disorders of the adult spine. The concept of circumferential interbody fusion has established itself in recent years, but has been afflicted by the impracicality of repositioning intraoperatively as well as only being able to address one aspect of the spine at a time. With single-position techniques, the surgeon is able to save operative time, reduce logistical problems of multi-position techniques, and operate on the spine from more than one approach simultaneously. As technology and surgeon familiarly increases, single-position interbody surgery is expected to gain even wider adoption in the adult spine field.

Interbody fusion devices are increasingly utilized in the field of adult lumbar spinal surgery. Surgical technique and device technology continues to improve upon the management of adult spinal pathology through indirect decompression, supplementation of the biological and mechanical properties of the local environment to encourage fusion, and directly addressing both sagittal and coronal deformity. Historically, interbody fusion was achieved through grafting and rudimentary devices. Recently, attention has been turned to the materials and design of interbody devices with the goal of providing the optimal interface between bone and the device to facilitate the fusion process. This review will provide historical context and address the current state of material science of interbody devices and design as well as outcomes and complications of various devices used in interbody reconstruction.