Access to the Lumbosacral Spine: A Current View

Abstract

The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Keywords

arthrodesis - lumbosacral region/surgery - spine/surgery - spinal fusion

Work developed at the Spine Group, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universiade de Sao Paulo, Sao Paulo, Brazil.

Publication History

Received: 08 February 2023

Accepted: 04 September 2023

Article published online:
10 April 2024

• Referências

• 1 Lee SH, Jeong SK, Bae J. Evolution of Spine Surgery as a Request of Endoscopic and Microscopic Laser to Technology. In: Bae J, Lee SH. editors. Laser Spine Surgery. Springer, Singapore; 2021: 1-8 . Available from: https://doi.org/10.1007/978-981-16-2206-9_1
• 2 Jones ET, Pickett JC. An operation for progressive spinal deformities. Clin Orthop Relat Res 1988; (229) 2-3
• 3 Capener N. Spondylolisthesis. Br J Surg 1932; 19 (75) 374-386
• 4 de Kunder SL, Rijkers K, Caelers IJMH, de Bie RA, Koehler PJ, van Santbrink H. Lumbar Interbody Fusion: A Historical Overview and a Future Perspective. Spine 2018; 43 (16) 1161-1168
• 5 Mayer HM. A History of Endoscopic Lumbar Spine Surgery: What Have We Learnt?. BioMed Res Int 2019; 2019: 4583943
• 6 Allain J, Dufour T. Anterior lumbar fusion techniques: ALIF, OLIF, DLIF, LLIF, IXLIF. Orthop Traumatol Surg Res 2020; 106 (1S): S149-S157
• 7 Goodrich JT. History of spine surgery in the ancient and medieval worlds. Neurosurgical focus 2004; 16 (01) 1-13
• 8 Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 1994; 19 (02) 165-172
• 9 Posterior approach. Accessed November 16, 2022. Available from: https://surgeryreference.aofoundation.org/spine/deformities/adolescent-idiopathic-scoliosis/approach/posterior-approach
• 10 Gille O, Jolivet E, Dousset V. et al. Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine 2007; 32 (11) 1236-1241
• 11 He K, Head J, Mouchtouris N. et al. The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature. Global Spine J 2020; 10 (05) 657-666
• 12 Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine 1996; 21 (08) 941-944
• 13 Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine 1994; 19 (22) 2598-2602
• 14 Watkins MB. Posterolateral fusion in pseudarthrosis and posterior element defects of the lumbosacral spine. Clin Orthop Relat Res 1964; 35 (35) 80-85
• 15 Wiltse LL. The paraspinal sacrospinalis-splitting approach to the lumbar spine. Clin Orthop Relat Res 1973; 91 (91) 48-57
• 16 Palmer DK, Allen JL, Williams PA. et al. Multilevel magnetic resonance imaging analysis of multifidus-longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach. Spine 2011; 36 (16) 1263-1267
• 17 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 1988; 13 (06) 696-706
• 18 Street JT, Andrew Glennie R, Dea N. et al. A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine. J Neurosurg Spine 2016; 25 (03) 332-338
• 19 Guiroy A, Sícoli A, Masanés NG, Ciancio AM, Gagliardi M, Falavigna A. How to perform the Wiltse posterolateral spinal approach: Technical note. Surg Neurol Int 2018; 9: 38
• 20 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6 (04) 435-443
• 21 Li JX, Phan K, Mobbs R. Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications. World Neurosurg 2017; 98: 113-123
• 22 Mai HT, Schneider AD, Alvarez AP. et al. Anatomic Considerations in the Lateral Transpsoas Interbody Fusion: The Impact of Age, Sex, BMI, and Scoliosis. Clin Spine Surg 2019; 32 (05) 215-221
• 23 Watkins III RG, Watkins IV RG. Eds. Surgical Approaches to the Spine. New York, NY: Springer; 2015
• 24 Pawar A, Hughes A, Girardi F, Sama A, Lebl D, Cammisa F. Lateral Lumbar Interbody Fusion. Asian Spine J 2015; 9 (06) 978-983
• 25 Ito, HiroMu, JuNichi, Tsuchiya, Goichi Asami A new radical operation for Pott's disease: report of ten cases. JBJS 1934; 16 (03) 499-515
• 26 Brau SA. Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications. Spine J 2002; 2 (03) 216-223
• 27 Dias Pereira Filho AR. Technique for Exposing Lumbar Discs in Anterior Approach Using Steinmann Wires: Arthroplasties or Arthrodesis. World Neurosurg 2021; 148: 189-195
• 28 Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2015; 1 (01) 2-18
• 29 Wert Jr WG, Sellers W, Mariner D. et al. Identifying Risk Factors for Complications During Exposure for Anterior Lumbar Interbody Fusion. Cureus 2021; 13 (07) e16792
• 30 Manunga J, Alcala C, Smith J. et al. Technical approach, outcomes, and exposure-related complications in patients undergoing anterior lumbar interbody fusion. J Vasc Surg 2021; 73 (03) 992-998
• 31 Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 2018; 6 (06) 104-104
• 32 Safaee MM, Tenorio A, Osorio JA. et al. The impact of obesity on perioperative complications in patients undergoing anterior lumbar interbody fusion. J Neurosurg Spine 2020; 33 (03) 1-10
• 33 Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 1997; 22 (06) 691-699 , discussion 700
• 34 Silvestre C, Mac-Thiong JM, Hilmi R, Roussouly P. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J 2012; 6 (02) 89-97
• 35 OLIF Procedures | Medtronic. Accessed November 17, 2022. Available from: https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/spinal-orthopaedic/olif.html
• 36 Molinares DM, Davis TT, Fung DA. Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study. J Neurosurg Spine 2016; 24 (02) 248-255
• 37 Zairi F, Sunna TP, Westwick HJ. et al. Mini-open oblique lumbar interbody fusion (OLIF) approach for multi-level discectomy and fusion involving L5-S1: Preliminary experience. Orthop Traumatol Surg Res 2017; 103 (02) 295-299
• 38 Li R, Li X, Zhou H, Jiang W. Development and Application of Oblique Lumbar Interbody Fusion. Orthop Surg 2020; 12 (02) 355-365
• 39 Hermantin FU, Peters T, Quartararo L, Kambin P. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 1999; 81 (07) 958-965
• 40 Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993; 78 (02) 216-225
• 41 Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 2008; 33 (09) 931-939
• 42 Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 2010; 19 (02) 181-204
• 43 Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J 2016; 25 (01) 134-143
• 44 Li XC, Zhong CF, Deng GB, Liang RW, Huang CM. Full-Endoscopic Procedures Versus Traditional Discectomy Surgery for Discectomy: A Systematic Review and Meta-analysis of Current Global Clinical Trials. Pain Physician 2016; 19 (03) 103-118
• 45 Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A. Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: A meta-analysis. Int J Surg 2016; 31: 86-92
• 46 Ruetten S, Komp M, Merk H, Godolias G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 2009; 22 (02) 122-129