Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls
김영훈, 하기용, 유기원, 박형열, 조창희, 김훈철, 이효진, 김상일,
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김영훈 ( Kim Young-Hoon )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Orthopedic Surgery
하기용 ( Ha Kee-Yong )
Kyung Hee University Hospital at Gangdong Department of Orthopedic Surgery
유기원 ( Rhyu Kee-Won )
Catholic University College of Medicine St. Vincent’s Hospital Department of Orthopedic Surgery
박형열 ( Park Hyung-Youl )
Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Orthopedic Surgery
조창희 ( Cho Chang-Hee )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Orthopedic Surgery
김훈철 ( Kim Hun-Chul )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Orthopedic Surgery
이효진 ( Lee Hyo-Jin )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Orthopedic Surgery
김상일 ( Kim Sang-Il )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Orthopedic Surgery
Abstract
Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.
키워드
Lumbar vertebrae; Intervertebral disc; Spinal fusion; Minimally invasive surgery; Interbody fusion
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