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. 2008 May;17(5):691-7.
doi: 10.1007/s00586-008-0644-7. Epub 2008 Mar 8.

Mini-open Anterior Spine Surgery for Anterior Lumbar Diseases

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Free PMC article

Mini-open Anterior Spine Surgery for Anterior Lumbar Diseases

Ruey-Mo Lin et al. Eur Spine J. .
Free PMC article

Abstract

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified "mini-open anterior spine surgery" (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24-52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12-L1, 18 at L1-L2, 18 at L2-L3, 22 at L3-L4 and 11 at L4-L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62-124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4-26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

Figures

Fig. 1
Fig. 1
aDashed line (a, b, c, d) indicates possible incisions for mini-open anterior spinal surgery. The level could be below the 12th rib, between the 11th and 12th ribs or even up to the 9th or 10th rib. Severance of muscle layers was the rule to avoid injuries to the intercostal or subcostal nerves, and usually 2–3 cm below the target provided adequate exposure; b the ENT forceps indicate the dissected intercostal muscles between the 10th and 11th ribs; a short segment of the 11th rib was already cut. Directly under the intercostalis is the fibrotendinous portion of the transverse abdominal muscle (arrow); c splitting this fibrotendinous portion, the retroperitoneal space was exposed
Fig. 2
Fig. 2
A 57 year-old female who suffered from motion pain and left L5 sciatica for years. Dynamic X-ray showed L4–5 degenerative spondylolisthesis with spinal instability. The MOASS technique was performed and the lower screw was inserted obliquely to avoid ligating the segmental vessels (arrow). She had an excellent clinical outcome; 3.5 years later, we noted solid interbody fusion at L4–5
Fig. 3
Fig. 3
A 74 year-old female who suffered from L1–2 osteomyelitis (E. coli). She received debridement and anterior spinal fusion with autogenous tricortical bone grafts through mini-open surgery. Two years later, there were no complaints or symptoms. Solid interbody fusion was noted, although the L1 screw migrated slightly (arrow)
Fig. 4
Fig. 4
A 51-year-old female who received the MOASS technique for an old bursting fracture. A mesh stuffed with block allografts was used as the anterior support. Radiography 1 year later showed no loss of correction

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