Access to the Lumbosacral Spine: A Current View.

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.

Access to the Lumbosacral Spine: A Current View / Acesso à coluna lombossacral: Visão atual

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.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. METHODS: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. RESULTS: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% (P < .001). The canal area increased from 109 to 149 mm2 (P < .001) and from 9.3 to 12.2 mm (P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides (P < .001). The height of the foramen showed significant average increase of 2.8 mm (P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. CONCLUSION: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.