neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2023-25-3-119-125neurosurgery-1418Research ArticleЛЕКЦИЯLECTUREПередний поясничный межтеловой спондилодез: обзор процедуры и связанные с ней осложненияAnterior lumbar interbody fusion (ALIF): a review of the procedure and associated complicationshttps://orcid.org/0000-0001-8710-8652МусаДж.MusaG.

Gerald Musa

117198 Москва, ул. Миклухо-Маклая, 6

Gerald Musa

Medical Institute

6 Miklukho-Maklaya St., Moscow 117198

gerryMD@outlook.comhttps://orcid.org/0000-0001-5332-6811КастильоР.Е. Б.CastilloR.E. B.

117198 Москва, ул. Миклухо-Маклая, 6

Medical Institute

6 Miklukho-Maklaya St., Moscow 117198

НдандьяД.Т. К.NdandjaD.T. K.

117198 Москва, ул. Миклухо-Маклая, 6

Medical Institute

6 Miklukho-Maklaya St., Moscow 117198

МвелаБ. М.MwelaB. M.

117198 Москва, ул. Миклухо-Маклая, 6

Medical Institute

6 Miklukho-Maklaya St., Moscow 117198

ЧмутинГ. Е.ChmutinG. E.

117198 Москва, ул. Миклухо-Маклая, 6

Medical Institute

6 Miklukho-Maklaya St., Moscow 117198

АнтоновГ. И.AntonovG. I.

117198 Москва, ул. Миклухо-Маклая, 6; 143420 Московская обл., п. Новый

6 Miklukho-Maklaya St., Moscow 117198; Noviy, Moskow region 143420

СлабовМ. В.SlabovM. V.

Нейрохирургическое отделение 

115446 Москва, Коломенский проезд, 4

Department of Neurosurgery

4 Kolomenskiy proezd, Moscow 115446

ФГАОУ ВО «Российский университет дружбы народов им. П. Лумумбы»РоссияRUDN UniversityRussian FederationФГАОУ ВО «Российский университет дружбы народов им. П. Лумумбы»; ФГБУ «3-й центральный военный клинический госпиталь им. А.А. Вишневского» Минобороны РоссииРоссияRUDN University; A.A. Vishnevsky 3 rd Central Military Clinical Hospital, Ministry of Defense of RussiaRussian FederationГБУЗ г. Москвы «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения города Москвы»РоссияS.S. Yudin City Clinical Hospital, Moscow Healthcare DepartmentRussian Federation202319102023253119125Copyright © Муса Д., Кастильо Р.Б., Ндандья Д.К., Мвела Б.М., Чмутин Г.Е., Антонов Г.И., Слабов М.В., 20232023Муса Д., Кастильо Р.Б., Ндандья Д.К., Мвела Б.М., Чмутин Г.Е., Антонов Г.И., Слабов М.В.Musa G., Castillo R.B., Ndandja D.K., Mwela B.M., Chmutin G.E., Antonov G.I., Slabov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1418

Дегенеративные заболевания межпозвоночных дисков и спондилоартроз поясничного отдела позвоночника часто встречаются у пожилых людей и являются самой распространенной причиной инвалидности. Хирургический межтеловой спондилодез на уровне вовлеченных позвонков – наиболее распространенный метод лечения. Это эффективный подход для стабилизации позвоночника и уменьшения боли, позволяющий косвенно снять компрессию с элементов нервной системы и восстановить лордоз с исправлением деформации. Описаны различные методы спондилодеза с разным доступом к позвоночнику. Передний поясничный межтеловой спондилодез (ППМС) дает возможность широкого обзора межпозвоночного диска, что позволяет использовать большие межтеловые эндопротезы, обладающие значительными биомеханическими преимуществами по сравнению с другими типами протезов. Трансперитонеальный доступ является относительно старым методом и используется редко, за исключением отдельных случаев тяжелого ретроперитонеального рубцевания после операций на брюшной полости. Трансперитонеальный доступ связан с большей частотой повреждений кишечника, кишечной непроходимости, ретроградной эякуляции и ограничен сегментом L5–S1, поэтому многие хирурги предпочитают ретроперитонеальный доступ. Главный недостаток ППМС – необходимость мобилизации множества сосудов, что может приводить к тромбозу глубоких вен и прямой травме сосудов. Поэтому на предоперационной стадии исследование анатомии сосудов является незаменимым этапом, необходимым для избежания травмы сосудов. Другие осложнения связаны с возможным повреждением интраперитонеальных и ретроперитонеальных органов, особенно у пациентов, которые ранее были оперированы и имеют рубцовое сращение. Манипуляции на кишечнике приводят к постоперационной кишечной непроходимости, сохраняющейся несколько дней. Сексуальная дисфункция в форме ретроградной эякуляции является еще одним осложнением у пациентов после ППМС, возникающим в результате травмы верхнего гипогастрального симпатического нерва в нижнем поясничном отделе.

В статье представлен обзор процедуры ППМС, в том числе с трансперитонеальным и ретроперитонеальным доступами, и связанные с ней интраоперационные, ранние и поздние осложнения.

Degenerative disc disease and facet joint disease involving the lumbar spine are common in the aging population and are the most frequent causes of disability. Surgical interbody fusion of degenerative levels is the most common management technique. This is an effective treatment option to stabilize the spine and reduce mechanical pain and provides indirect decompression of the neural elements while restoring lordosis and correcting the deformity. Depending on the direction of the approach to the vertebral column, various techniques have been described. Anterior lumbar interbody fusion (ALIF) offers clear and wide visualization of the disc allowing the use of large interbody grafts, which provide a significant biomechanical advantage over other types of fusion. The transperitoneal approach is a much older technique and it is not commonly performed unless in isolated cases with extensive retroperitoneal scaring following multiple abdominal surgeries. The transperitoneal approach has been associated with higher rates of bowel injury, ileus, and retrograde ejaculation, and is limited at the L5–S1 segment, hence many spine surgeons favor a retroperitoneal approach. The major setback of ALIF is the need for great vessel mobilization. This manipulation of the vessels may lead to deep vein thrombosis and a direct vascular injury. This makes vascular anatomy studies in the preoperative stage invaluable in avoiding vascular injury. Other complications include possible injury to intraperitoneal and retroperitoneal organs, especially in patients with previous surgery and adhesions. Manipulation of the intestines causes postoperative ileus which lasts a few days. Sexual dysfunction in form of retrograde ejaculation is another complication seen in patients following ALIF and this has been attributed to injury to the superior hypogastric sympathetic nerves in the lower lumbar region.

This article reviews the ALIF procedure i. e., transperitoneal and retroperitoneal approaches, and the associated intraoperative, early, and late complications.

передний поясничный межтеловой спондилодездегенеративные заболевания межпозвоночных дисковспондилоартрозпоясничный отдел позвоночникаспондилодезanterior lumbar interbody fusiondegenerative disc diseasefacet joint diseaselumbar spinespinal fusion For citПубликация была подготовлена при поддержке Программы стратегического академического лидерства Российского университета дружбы народов (РУДН).The publication was carried out with the support of the Peoples Friendship University of Russia (RUDN) Strategic Academic Leadership Program.ReferencesSihvonen T., Herno A., Paljärvi L. et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 1993;18(5):575–81. DOI: 10.1097/00007632-199304000-00009Sihvonen T., Herno A., Paljärvi L. et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 1993;18(5):575–81. DOI: 10.1097/00007632-199304000-00009Upadhyayula P.S., Curtis E.I., Yue J.K. et al. 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The authors declare that there are no conflicts of interest present.