Anterior Lumbar Fusions

摘要

Anterior lumbar spine fusions have increased in popularity as our understanding of spinal biomechanics, surgical anatomy, and technique has improved. Two main approaches to the anterior lumbar spine are available: transperitoneal and retroperi-toneal. The transperitoneal approach may used for low lumbar interbody fusions. The retroperitoneal approach is best for lesions involving the upper lumbar spine. Anterior lumbar fusions may incorporate interbody fusion with or without anterior instrumentation. Interbody fusions may be performed with bone, synthetic interbody spacers, or titanium cages that promote fusion and provide fixation. A number of anterior plating devices are now available that are relatively easy to apply above L5 and provide biomechanical stability. Surgical complications include injury to the nervous system (sympathetic plexus or cauda equina and conus) and vascular injury (including aorta, inferior vena cava). Long-term follow-up of patients undergoing lumbar fusions indicate a relatively low complication rate with a high fusion rate.