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ALIF approach

Julian Li, Kevin Phan, Ralph Mobbs
OBJECTIVE: Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are commonly used approaches for lumbar spine fusion surgery, each with their own unique advantages and disadvantages. ALIF requires mobilization of the great vessels and peritoneum, while dissection of the psoas muscle in the LLIF technique is associated with post-operative neurological complications in the proximal lower limb. The anterior-to-psoas (ATP) or oblique lumbar interbody fusion (OLIF) technique is the proposed solution to accessing the L1-L5 levels without the issues encountered with ALIF and LLIF...
October 21, 2016: World Neurosurgery
Mark J Winder, Shanu Gambhir
The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930's, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF)...
March 2016: J Spine Surg
Kevin Phan, Ralph J Mobbs, Prashanth J Rao
BACKGROUND: One of the proposed advantages of anterior lumbar interbody fusion (ALIF) is restoration of disc height and hence an indirect foraminal height restoration. While this proposed advantage is often quoted in the literature, there are few robust studies demonstrating restoration of foraminal volume. Thus, this study aimed to review the literature and discuss the progression and development of foramen measurement techniques. METHODS: A review of the literature was performed to identify studies which reported foraminal height and dimensions following fusion surgery in cadaveric models or patients...
December 2015: J Spine Surg
Ralph J Mobbs, Kevin Phan, Greg Malham, Kevin Seex, Prashanth J Rao
Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF)...
December 2015: J Spine Surg
Kevin Phan, Joshua Xu, Daniel B Scherman, Prashanth J Rao, Ralph J Mobbs
STUDY DESIGN: A systematic review and meta-analysis OBJECTIVE.: To investigate the outcomes of anterior lumber interbody fusion (ALIF) with and without an "access surgeon". SUMMARY OF BACKGROUND DATA: Anterior approaches for spine operations have become increasingly popular but may often involve unfamiliar anatomy and territory for spine surgeons, potentially placing the patient at risk to a greater proportion of approach-related complications. Thus many spine surgeons require or prefer the assistance of an "access surgeon" to perform the exposure...
September 23, 2016: Spine
Kevin Phan, Ralph J Mobbs
Anterior lumbar interbody fusion (ALIF) is one of the surgical procedures for the relief of chronic back pain, radiculopathy and neurogenic claudication in patients with degenerative lumbar spine disease that is refractory to conservative therapy, low-grade spondylolisthesis and pseudo arthrosis. Over the past half century, both the surgical techniques and instrumentation required for ALIF have changed significantly. In particular, the designs of ALIF cage and the materials used have evolved dramatically, the common goal being to improve fusion rates and optimize clinical outcomes...
August 2016: Orthopaedic Surgery
Gregory M Malham, Rhiannon M Parker, Carl M Blecher, Fiona Y Chow, Kevin A Seex
STUDY DESIGN: Retrospective analysis of prospectively collected registry data. OBJECTIVE: This study aimed to compare the clinical and radiologic outcomes between comparative cohorts of patients having anterior lumbar interbody fusion (ALIF) and patients having lateral lumbar interbody fusion (LLIF). METHODS: Ninety consecutive patients were treated by a single surgeon with either ALIF (n = 50) or LLIF (n = 40). Inclusion criteria were patients age 45 to 70 years with degenerative disk disease or grade 1 to 2 spondylolisthesis and single-level pathology from L1 to S1...
August 2016: Global Spine Journal
Yu Qian, Zhen Lin, Cong Jin, Xing Zhao, Minghao Zheng
STUDY DESIGN: Surgical approach development in an animal model, and a prospective study comparing clinical outcomes between novel and conventional approaches in thoracolumbar burst fracture fixation. OBJECTIVE: To investigate the feasibility of a less-invasive retroperitoneal approach to the lumbar spine in a sheep model and to compare the clinical outcomes of anterior reconstruction in the treatment of thoracolumbar burst fractures using novel and conventional approaches...
June 28, 2016: Clinical Spine Surgery
P-E Moreau, C-H Flouzat-Lachaniette, J Lebhar, G Mirouse, A Poignard, J Allain
PURPOSE: L4-L5 isthmic spondylolisthesis may be associated with lumbosacral transitional vertebrae (LSTV) and altered venous vascular anatomy. The objectives of this study were to describe the anatomical characteristics of L4-L5 ISPL and the intraoperative difficulties encountered during the approach for anterior lumbar interbody fusion (ALIF). METHODS: This is a retrospective review of 20 ALIFs for L4-L5 ISPL. The anatomy of the common iliac veins confluence and the position of L4-L5 with respect to the projection of the iliac crest were analysed on CT-scan...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Brant W Ullery, Patrick Thompson, Matthew W Mell
BACKGROUND: We describe successful anterior retroperitoneal spine exposure to facilitate anterior lumbar interbody fusion (ALIF) in a patient with a prior endovascular aneurysm repair (EVAR). METHODS: A 74-year-old male with an extensive spine surgical history presented with progressive neurogenic claudication and paresthesia involving both feet. In addition, his surgical history was notable for an EVAR performed elsewhere 5 years earlier, with subsequent right renal stent placement for encroachment of the right renal artery...
August 2016: Annals of Vascular Surgery
Scott VanValkenburg, J C Trussell, William F Lavelle
Iatrogenic ureteral injuries are rare and must be accurately identified to minimizing the risk for additional complications. Anterior lumbar interbody fusion (ALIF) is a valuable technique utilized in spine surgery, with its own unique set of complications. For example, retroperitoneal fluid collections, following ALIF surgery are rare and may result in back pain, radicular pain, nausea, and even death. It is important to rapidly identify the nature of the fluid collection to clarify appropriate management options...
April 2016: Canadian Journal of Urology
Sean Molloy, Joseph S Butler, Adam Benton, Karan Malhotra, Susanne Selvadurai, Obiekezie Agu
BACKGROUND CONTEXT: A variety of surgical approaches have been used for cage insertion in lumbar interbody fusion surgery. The direct anterior approach requires mobilization of the great vessels to access the intervertebral disc spaces cranial to L5/S1. With the lateral retroperitoneal transpsoas approach, it is difficult to access the L4/L5 intervertebral disc space due to the lumbar plexus and iliac crest, and L5/S1 is inaccessible. We describe a new anterolateral retroperitoneal approach, which is safe and reproducible to access the disc spaces from L1 to S1 inclusive, obviating the need for a separate direct anterior approach to access L5/S1...
June 2016: Spine Journal: Official Journal of the North American Spine Society
Didier Recoules-Arche, Claudia Druschel, Paul Fayada, Laurent Vinikoff, Alexander C Disch
STUDY DESIGN: Description of the technique and retrospective study of patients treated with unilateral extraforaminal lumbar interbody fusion (ELIF) for degenerative lumbar spinal disorders. OBJECTIVE: To investigate clinical and radiologic outcome of patients treated with unilateral ELIF. SUMMARY OF BACKGROUND DATA: Lumbar interbody fusion is the classic treatment for higher grades of degenerative disk disease or lumbar segment instability and is performed by posterior (PLIF), posterolateral, or anterior (ALIF) approaches...
April 2016: Clinical Spine Surgery
Maiwulanjiang Mamuti, Shunwu Fan, Junhui Liu, Zhi Shan, Chongyan Wang, Shengyun Li, Fengdong Zhao
STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study is to evaluate, clinically and radiographically, the efficacy of mini-open retroperitoneal anterior lumbar discectomy followed by anterior lumbar interbody fusion (ALIF) for recurrent lumbar disc herniation following primary posterior instrumentation. SUMMARY OF BACKGROUND DATA: Recurrent disc herniation following previous disc surgery occurs in 5 to 15% of cases. This is often treated by further surgical intervention where posterior approach is generally preferred...
September 15, 2016: Spine
Roger Härtl, Alexander Joeris, Robert A McGuire
PURPOSE: To review the evidence on safety of anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders with an emphasis on the association between neuromonitoring and complications. METHODS: We performed a systematic literature search in the Cochrane (CENTRAL), MEDLINE, EMBASE and the FDA Medical Devices databases. We abstracted information on study design, sample size, population, procedure, number and location of involved levels, follow-up time and complications, as well as information on conflict of interest and source of funding...
May 2016: European Spine Journal
Ralph J Mobbs, Kevin Phan, Daniel Daly, Prashanth J Rao, Andrew Lennox
Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team...
March 2016: Global Spine Journal
Kevin Phan, Ralph J Mobbs
We report the case of a 75-year-old lady who presented with a L2-3 non-union 18 months following a L2-3 and L3-4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L2 pedicle screws on imaging was consistent with a non-union at the L2-3 level. An anterior lumbar interbody fusion (ALIF) approach was originally considered. However, due to the high lumbar approach and patient habitus [body mass index (BMI) > 35], a decision was made to approach the L2-3 level using an oblique technique...
November 2015: Orthopaedic Surgery
Ruth M Parks, Eyal Behrbalk, Syed Mosharraf, Roger M Müller, Bronek M Boszczyk
Study Design Prospective follow-up design. Objective Ureteral injury is a recognized complication following gynecologic surgery and can result in hydronephrosis. Anterior lumbar surgery includes procedures like anterior lumbar interbody fusion (ALIF) and total disk replacement (TDR). Anterior approaches to the spine require mobilization of the great vessels and visceral organs. The vascular supply to the ureter arising from the iliac arteries may be compromised during midline retraction of the ureter, which could theoretically lead to ureter ischemia and stricture with subsequent hydronephrosis formation...
December 2015: Global Spine Journal
Daniel Lubelski, Seth K Williams, Colin O'Rourke, Nancy A Obuchowski, Jeffrey C Wang, Michael P Steinmetz, Alfred J Melillo, Edward C Benzel, Michael T Modic, Robert Quencer, Thomas E Mroz
STUDY DESIGN: Electronic survey. OBJECTIVE: To identify the surgical treatment patterns for low back pain (LBP), among U.S. spine surgeons. Specifically determine (1) differences in surgical treatment responses based on various demographic variables; (2) probability of disagreement based on surgeon subgroups. SUMMARY OF BACKGROUND DATA: Multiple surgical and nonsurgical treatments exist for LBP. Without strong evidence or clear guidelines for the indications and optimal treatments, there is substantial variability in surgical treatments used...
June 2016: Spine
Kevin Phan, Jarred A Hogan, Yusuf Assem, Ralph J Mobbs
Recent developments have seen poly[aryl-ether-ether-ketone] (PEEK) being increasingly used in vertebral body fusion. More novel approaches to improve PEEK have included the introduction of titanium-PEEK (Ti-PEEK) composites and coatings. This paper aims to describe a potential complication of PEEK based implants relating to poorer integration with the surrounding bone, producing a "PEEK-Halo" effect which is not seen in Ti-PEEK composite implants. We present images from two patients undergoing anterior lumbar interbody fusion (ALIF)...
February 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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