The AnteroLateral transPsoatic Approach (ALPA) - A new technique for implanting prosthetic disc-nucleus devices
The AnteroLateral transPsoatic Approach (ALPA) - A new technique for implanting prosthetic disc-nucleus devices
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DOI：
10.1097/00024720-200308000-00012
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发表时间：
2003-08-01
影响因子：
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通讯作者：
Vazquez, RJ
中科院分区：
文献类型：
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作者：
Bertagnoli, R;Vazquez, RJ
人工髓核装置传统上是通过腰椎减压手术的标准后路植入的。为了避免破坏脊柱的后部结构和促进内固定装置的植入，经前外侧经腰椎入路(ALPA)已被开发出来。在ALPA手术中，在腰椎间盘上方的外侧区域切开，钝性地剥离腹侧肌肉。进入腹膜后区域并跟随到腰大肌，在那里使用沿着肌肉纤维方向的钝性剥离到达受影响的椎间盘。切断盘环形成瓣，取出髓核材料，将假体植入盘腔内。手术结束时，环状瓣在通往核孔的位置缝合，伤口以正常方式闭合。通过ALPA技术，一个由8名患者组成的小研究小组已经植入了PDN假体髓核装置。初步结果显示与手术技术有关的轻微不良反应。临床结果也令人鼓舞，OSwestry和PROLO评分有了显著改善，椎间盘高度也相应增加。ALPA技术是后路半椎板切开入路在退变腰椎间盘内植入髓核装置的良好替代方法。
Prosthetic disc-nucleus devices have traditionally been implanted via the same posterior approach that is standard for lumbar decompression surgery. To avoid disrupting the posterior structures of the spine and to facilitate device implantation, the AnteroLateral transPsoatic Approach (ALPA) has been developed. With ALPA, an incision is made in the lateral region overlying the disc, and the lateroabdominal muscles are bluntly dissected. The retroperitoneal area is accessed and followed to the psoas muscle, where blunt dissection in the direction of the muscle fibers is used to reach the affected disc. The disc anulus is cut to create a flap, the nucleus pulposus material is removed, and the prosthesis is implanted into the disc cavity. The procedure concludes with the anulus flap being sutured in place over the opening to the nucleus, and the wound is closed in a normal manner. A small study group of eight patients has been implanted with PDN prosthetic disc-nucleus devices by way of the ALPA technique. Preliminary results indicate minor adverse events related to the surgical technique. Clinical results are also encouraging with significant improvements in Oswestry and Prolo scores and with an associated increase in disc height. The ALPA technique is a good alternative to the posterior hemilaminotomy approach for implanting nucleus devices in degenerated lumbar discs.