Video-assisted minimally invasive lumbar total disc replacement.

摘要

Although anterior surgical approaches to the lumbar spine to perform fusion or TDR have a long history, several innovative and less invasive options have been recently introduced 1, 2. For several years the anterior retroperi-toneal approach to the lower lumbar spine for interbody fusion (ALIF) 6 or the insertion of artificial disc (TDR) has become an established technique but uncommon in our country. This approach has several advantages over the posterior 3, 4. It allows direct access to the disc, avoids epidural fibrosis, and, above all the damage of the back muscles due to denervation often responsible for residual "low back pain". The development of new technologies has led to the introduction of the concept of minimally invasive spinal surgery 5. At the lower lumbar levels (L4-S1), the anterior approach can be performed through a small video-assisted retroperitoneal exposure, allowing optimal illumination and magnification of the field work 7. The surgical technique is presented to implant artificial disc (TDR) for a symptomatic degenerative disc disease (Pfirrmann 4/5) at L5-S1.