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Exploration of the Extraperitoneal Approach for Single-Level Anterior Lumbar Interbody Fusion: Imaging, Anatomical and Clinical Research

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Abstract

Background

To explore extraperitoneal approach as an optimal option for reducing peritoneal disruption at a single-level disc in anterior lumbar interbody fusion (ALIF).

Methods

First, abdominal axial CT images obtained from 111 patients were observed to evaluate the distribution of extraperitoneal fat at L2-S1 and measure the lateral distances between the midline and the lateral borders of the rectus and the extraperitoneal fat for each disc level. Second, eight embalmed corpses were dissected along the lateral border of the rectus to expose the peritoneum, which was then separated laterally and medially to evaluate the distribution of fat and peritoneum adhesion. Finally, a total of 58 patients were selected for ALIF. For L2-L4 discs and L4-S1, the pararectus approach and the paramedian approach were utilized, respectively.

Results

Extraperitoneal fat was observed behind the rectus at the L5-S1 and the lateral distance between the fat and midline and the lateral border of the rectus gradually decreased on both sides of L2-5. On the cranial side of the arcuate line, it was easier to separate the peritoneum outward along the lateral edge of the rectus. When bluntly dissected medially, the peritoneum was closely adhered to abdominal wall. No complications such as peritoneal damage, retroperitoneal hematoma and neurological complications occurred in 58 patients undergoing the aforementioned surgical methods.

Conclusions

For L4-S1, the paramedian approach is the optimal technique to expose the disc, whereas the pararectus approach is the feasible surgical method at L2-4.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The National Natural Science Foundation of China (82072491) and the Natural Science Foundation of Tianjin (20JCYBJC008200) were received in support of this work.

Author information

Author notes

  1. Kexin Qin, Heshun Tian, Kunsheng Zhang, Kaihui Zhang, Lilong Du, Bingshan Yan, Zhenxin Huo, Mingzhi Deng and Baoshan Xu have equal contribution to this research.

Authors and Affiliations

  1. Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, 406. No, Jiefangnan Road, Hexi District, Tianjin, 300211, China

    Kexin Qin, Heshun Tian, Kunsheng Zhang, Kaihui Zhang, Lilong Du, Bingshan Yan, Zhenxin Huo, Mingzhi Deng & Baoshan Xu

  2. Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China

    Kexin Qin, Heshun Tian, Kunsheng Zhang, Kaihui Zhang, Lilong Du, Bingshan Yan, Zhenxin Huo & Mingzhi Deng

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Contributions

KXQ drafted the manuscript; BSX designed the study; KXQ and KSZ dissected cadaver specimens and recorded data; HST analyzed data; BSX managed patients and performed surgery; LLD and KHZ reviewed and revised the manuscript; all the authors read and approved the final manuscript.

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Correspondence to Baoshan Xu.

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This study was approved by Institutional Review Board of the tertiary care centre.

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Informed consent was obtained from all individual participants included in the study.

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Qin, K., Tian, H., Zhang, K. et al. Exploration of the Extraperitoneal Approach for Single-Level Anterior Lumbar Interbody Fusion: Imaging, Anatomical and Clinical Research. JOIO 57, 891–898 (2023). https://doi.org/10.1007/s43465-023-00869-8

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  • DOI: https://doi.org/10.1007/s43465-023-00869-8

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