A Little-Invasive Anterior Retroperitoneal Approach in Surgery of the Lumbar Spine Instability: The First Experience

V.V. Rudenko, A.P. Tatarintsev, D.A. Rzaev, D.V. Leiko, I.L. Pudovkin

(Vreden Research Institute of Traumatology and Orthopedics, Saint Petersburg)

Despite presence of modern methods, as well as numerous fixing devices, which are being constantly improved, problem of surgical treatment of the spine instability is still urgent. A growth of poor results is directly proportional to a surgeon’s aggressiveness and an increasing number of surgical interventions.

Preference of either rigid or dynamic fixation is a subject of continuous discussion. An arsenal of rigid fixation, mastered by neurosurgeons, is practically limited to use of transpedicular systems and PLIF. As for anterior surgical accesses, neurosurgeons have yielded the palm to orthopedists and have almost lost this field of activity. Interspinal spondylodesis, osteoplasty are not used independently and cannot be considered as methods, which guarantee primary stabilization.

Difficulty of instability treatment is conditioned by extremely great dynamic and static loads on the spine, being a complex biomechanical system.

A method of anterior decompression and stabilization is based on synthesis of neurosurgical and orthopedic principles. There were 31 cases with different types of instability in the lumbar spine, operated during 2 years. The main indications for surgery included clinical manifestations of instability, confirmed by CT and MRI findings, plain and functional spondylograms. The distribution of cases was as follows: dynamic instability – 6, spondylolisthesis of the first and second degree – 17 (12 and 5 of them had degenerative instability and spondylolytic spondylolisthesis respectively), relapses of disc hernias after conventional interventions – 8 cases. All the cases were examined a month, half a year and a year after operation. Some cases were followed up during more than 1 year. According to data of spiral CT, there was a bone block, formed by the third month. Clinical estimation of treatment results was carried out on the basis of Karnosvky scale. Good and satisfactory results were watched in 27 (87%) and 4 (13%) cases respectively.

The article contains information on anatomic, theoretical, rentgenologic and biomechanical prerequisites of broad introduction and use of ALIF technology.