Intertransverse lumbar interbody fusion.

Abstract

Cadaver dissection and case reports were used to describe a novel technique of lumbar interbody arthrodesis that accesses the intervertebral disc through a posterolateral intertransverse process approach. To describe the surgical approach and technique required in performing an intertransverse lumbar interbody fusion. The clinical results in two patients with 2-year follow-up evaluation after intertransverse lumbar interbody fusion are reported. Many of the complications of lumbar interbody arthrodesis are associated with the surgical approach to the disc space. During an anterior approach, intraabdominal or retroperitoneal structures are at risk, whereas during a posterior approach, the cauda equina and spinal stabilizers may be jeopardized. A minimally invasive posterolateral discectomy for the treatment of herniated lumbar discs has been described. The authors hypothesized that a posterolateral approach might be used for achieving interbody arthrodesis. Cadaver studies were performed to determine the feasibility and define the anatomy of a posterolateral, intertransverse process approach used to achieve lumbar interbody arthrodesis. These studies confirmed that this approach is feasible at L3-L4 and L4-L5. In two patients with discogenic low back pain, an intertransverse lumbar interbody fusion was performed using structural allograft bone wedges with supplemental translaminar facet screws. In two patients, an intertransverse lumbar interbody fusion was successfully performed without any complication. Both patients demonstrated good surgical outcomes 2 years after surgery, and radiographic assessment showed stable interbody grafts without motion on flexion-extension studies. This preliminary report suggests that lumbar interbody arthrodesis can be accomplished with a posterolateral intertransverse process approach. To the authors' knowledge, this is the first published report describing this approach for performing an interbody arthrodesis. The intertransverse lumbar interbody fusion (ILIF) approach avoids the need for either intraabdominal dissection or violation of the spinal canal-neural foramen in accessing the disc. This technique may therefore present an opportunity to accomplish a minimally invasive approach to lumbar fusion.