Abstract
Lumbar anterior column spine surgery uses minimally invasive anterior and lateral retroperitoneal techniques for the insertion of wide footprint interbody devices to provide indirect neural decompression and correct deformity.
The utility and reliability of co-registration of isotope bone scans with CT and MRI to identify spinal pathology, location of pain and facilitate surgical planning was investigated.
We undertook prospective studies on the learning curve for lateral lumbar interbody fusion, indication for standalone cages, success of indirect decompression, influence of facet arthropathy, factors causing cage subsidence and techniques to mitigate the risk of subsidence.
The clinical outcomes, fusion rates and complications of anterior lumbar interbody fusion were evaluated with the benefits of brief intraoperative heparinisation. Anterior versus lateral interbody fusions were compared at 2-year follow-up.
We investigated the benefits of performing anterolateral lumbar interbody fusion in obese patients positioned lateral decubitus over multiple levels in a single position.
Recommendations for performing these available lateral, anterior and anterolateral interbody fusions at each spinal level for different indications were compared.The techniques and a treatment algorithm to guide the need for supplemental fixation in anterior, lateral and anterolateral interbody fusions were discussed. Bone graft substitutes to avoid or augment iliac crest autograft harvest were evaluated. The fusion rates, clinical outcomes, complications and cancer risk of bone morphogenetic proteins were determined over a ten-year period then compared prospectively with a new calcium phosphate bone substitute alternative.
Advanced applications of these minimally invasive techniques include anterior resection of symptomatic developmental lumbo-pelvic pseudoarthrosis and the lateral approach for thoracolumbar corpectomy and thoracic discectomy.
Motion preservation adjacent to an anterior column fusion, by either anterior or lateral artificial disc replacement, were discussed with indications, complications, revision strategies and salvage options.
Guidelines were provided to assist hospital administrators and surgeons for the purchase and applications of currently available image guidance, navigation and robotic systems to improve the accuracy of pedicle screw placement.