J Korean Soc Spine Surg.  2016 Dec;23(4):262-269. 10.4184/jkss.2016.23.4.262.

Minimally Invasive Lateral Lumbar Interbody Fusion: Surgical Technique and Review

• Soh J
• Lee JC

• KMID: 2365088
• DOI: http://doi.org/10.4184/jkss.2016.23.4.262

Abstract

STUDY DESIGN: Review of the current surgical technique and literature.
OBJECTIVES
The aim of this study was to review the surgical technique and the current evidence on minimally invasive lateral lumbar interbody fusion (LLIF). SUMMARY OF LITERATURE REVIEW: Spinal fusion is a useful method in the treatment of various degenerative lumbar diseases. Recently, minimally invasive LLIF has been developed, enabling spine surgeons to perform anterior interbody fusion in a minimally invasive manner.
MATERIALS AND METHODS
Review of the surgical technique and the literature.
RESULTS
Minimally invasive LLIF may reduce the incidence of complications of anterior lumbar interbody fusion. LLIF may restore disc height more effectively than posterior lumbar interbody fusion and indirectly decompress the neural canal without nerve root or dural retraction or perineural scaring. The current indications for LLIF are almost equivalent to those of anterior and posterior lumbar interbody fusion. Recent studies have reported no differences in the fusion rate or clinical outcomes between LLIF and the conventional anterior or posterior interbody fusion techniques. However, LLIF has nonspecific complications, such as anterior thigh pain and hip flexor weakness.
CONCLUSIONS
Minimally invasive LLIF is a promising surgical alternative to the conventional anterior or posterior fusion techniques. LLIF has the advantages of less intraoperative bleeding and soft tissue injury, and a faster return to work. However, postoperative nonspecific complications are problems that need to be addressed.

Keyword

Lumbar; Degenerative lumbar disease; Minimally invasive lateral lumbar interbody fusion

MeSH Terms

Hemorrhage
Hip
Incidence
Methods
Neural Tube
Return to Work
Soft Tissue Injuries
Spinal Fusion
Spine
Surgeons
Thigh

Figure

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  Fig. 1. Preoperative lumbar bending radiographs show that the right-side approach to the L4-L5 disc space appears to be easier than the left-side approach (A) (see arrows). This evaluation is important, especially when the L4-L5 disc space is partially ob-structed by one of the iliac crests on lateral radiographs (B) (see arrows).

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  Fig. 2. A photograph shows the preoperative position of the patient. The posture of the patient is lateral on a bent operative table with hip and knee flexed.

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  Fig. 3. Intraoperative fluoroscopic anteroposterior and lateral images show the optimal placement of the tubular retractor for the operation.

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  Fig. 4. A schematic figure shows the difference between the direct lateral interbody fusion and oblique lateral interbody fusion approaches for the lumbar spine (see arrows). A, abdominal aorta; V, vena cava.

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  Fig. 5. Postoperative lumbar anteroposterior and lateral radiographs show the proper placement of cages.

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