Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This technique demonstrates adequate compression of the spinal canal without damaging important structures such as peritoneum, blood vessels, and the With the help of the retractor, the spinal canal can be more clearly exposed and decompressed with the help of a microscope. After administering general anesthesia, position the patient in the supine position. Subsequently fix a Kirschner needle on the lateral side of the abdomen.

Use the location of the Kirschner needle under X-ray to locate the surgical lumbar segment. Mark the surgical incision site according to the location of segment. Then make a five centimeter transverse incision in the lateral rectus abdominis muscle next to the lower abdomen.

Under a microscope set at a working distance of 535 millimeters, identify and incise the anterior rectus abdominis sheath. Then separate the rectus abdominis muscle bluntly to its outer edge, and use a pulling hook to retract the outer edge of the rectus abdominis toward the midline, revealing the posterior rectus abdominis sheath. Then separate the abdominal transverse fascia and anterior lateral abdominal wall of the peritoneum with gauze balls, and push contralaterally into the retroperitoneal space to reach the anterior aspect of the vertebral space.

Then utilize vascular forceps and nerve strippers to separate the iliac arteriovenous vein. Additionally, ligate the median sacral artery with silk thread depending on its occlusion. Separate the prevertebral soft tissue with gauze and vascular forceps.

Then explore the sacral vascular space under a microscope. Next, use a spreader to expose the surgical field in all directions. Next, use a retractor that has three attachment holes at different depths, and connect the straight-grip pull rod to the retractor.

Have an assistant attach a T-pusher to the opposite side to assist the surgeon and pushing away the soft tissue. Then use a 3.2 millimeter diameter positioning tube to secure the spreader to two adjacent vertebral bodies of the operated segment. Remove the diseased disc, and under the guidance of a microscope, remove the posterior longitudinal ligament.

Then decompress the nerve root. Next, perform endoscopic hemostasis and implant a suitable interbody fusion cage. Finally, use appropriate internal fixation according to the diagnosis.

This study included 42 patients for mini-ALIF surgery, which included cases of lumbar spondylolisthesis, discogenic back pain, and disc herniation. 30 patients underwent single-segment surgery and 12 underwent double-segment surgery. The mean operative time was 143 minutes, and the mean hospital stay was seven days.

Comparison of the heights of the intervertebral discs and the foramina of the operated segments of the patients showed that the heights in each follow-up period were significantly higher than those before the operation, highlighting a good indirect decompression effect. MRI of the lumbar spine of this patient showed a herniated disc at L-5 to S-1, biased toward the left foramen position seven days before the surgery. However, three days after the surgery, the herniated disc disappeared.

Microscope-assisted mini ALIF is very suitable for beginner, which can greatly reduce the occurrence of extra damage, but it requires patient and careful operation.