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Die extrem laterale interkorporelle Fusion

Indikationen, Technik, Ergebnisse und Komplikationsmöglichkeiten

Extreme lateral interbody fusion

Indication, surgical technique, outcomes and specific complications

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Zusammenfassung

Hintergrund

Die extrem laterale interkorporelle Fusion („extreme lateral interbody fusion“, XLIF) stellt eine interkorporelle Fusionstechnik dar, die über einen streng seitlichen, transpsoatischen Zugang geführt wird. Der Zugang ist für die Segmente kranial von L5 bis ca. Th5 möglich. Im lumbalen Bereich ist für die Psoaspassage zum Schutz des Plexus lumbosacralis ein Neuromonitoring obligat.

Fragestellung

Die Arbeit befasst sich mit den ersten Ergebnissen der XLIF-Technik sowie einem Vergleich zu Standardtechniken. Die bisherigen relevanten Publikationen zu den Themen „Indikation, Technik, spezifische Komplikationen, Ergebnisse“ werden zusammengestellt und auf diesem Hintergrund diskutiert.

Material und Methode

Anhand der Literaturübersicht werden Vor- und Nachteile der XLIF-Technik diskutiert.

Ergebnisse

Die Methode stellt hinsichtlich der Indikation und der technischen Optionen für die Segmentrekonstruktion eine Alternative zur anterioren interkorporellen Fusion (ALIF) sowie zu ventrolateralen interkorporellen Fusionen dar. Die XLIF-Technik bietet aufgrund des minimal-invasiven Zugangs potentiell eine geringere Zugangsmorbidität als offene Verfahren, weiterhin ist der Zugangsweg hinsichtlich der Komplikationsmöglichkeiten der großen Gefäße günstig.

Schlussfolgerung

Die Technik findet zunehmend Anwender. Verfügbare Ergebnisse zeigen eine sichere und reproduzierbare Anwendung bei Deformitäten, Anschlussversorgungen und Instabilitäten.

Abstract

Background

Extreme lateral interbody fusion (XLIF) is an interbody fusion technique, in which access to the lateral part of the disc is achieved via a strong lateral transpsoatic approach. In general, the technique can be applied between T5 and L5. For lumbar segments, neuromonitoring is mandatory to protect the iliolumbar plexus during the psoas passage.

Objectives

In this article, the results regarding use of the XLIF technique are summarized and compared with other anterior and anterolateral approaches. In addition, current publications regarding indication, technique, complications and clinical/radiological outcome measures are discussed.

Methods

The results of a literature review are presented and discussed.

Results

Regarding the indication and the surgical options for segmental restoration, the XLIF technique is comparable to anterior or anterolateral and open lateral interbody fusion. The minimally invasive XLIF access promises potentially lower morbidity than open procedures and the risk of injury of the iliac vessels is lower than in anterior and anterolateral approaches.

Conclusion

Increasing numbers of spine surgeons are using the XLIF method. Current results indicate that XLIF is a safe and reproducible technique for deformities, adjacent level disease, and instability.

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Authors and Affiliations

  1. Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland

    Markus Quante & Henry Halm

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  1. Markus Quante
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  2. Henry Halm
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Correspondence to Markus Quante.

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M. Quante und H. Halm sind als Referenten für die Fa. Silony und Nuvasive tätig und erhalten Beraterhonorare der Fa. Silony.

Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Quante, M., Halm, H. Die extrem laterale interkorporelle Fusion. Orthopäde 44, 138–145 (2015). https://doi.org/10.1007/s00132-014-3070-z

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