The aim is to facilitate the learning of Lumbar approaches and interbody fusion.

1. Dr.Shrijith MB
MS(Ortho),DNB
Fellow ,Spine Surgery
All India Institute of Medical Sciences ,New Delhi

2.  WHY ANTERIOR APPROACH ?
 ADVANTAGES - BIOMECHANICAL
 - FUSION OUTCOMES
 - SAGGITAL PROFILE

3.  SURGICAL ANATOMY
 ANT VS POST
 BIOMECHANICAL
 SAFETY PROFILE
 CHALLENGES IN APPROACH
 APPROACHES :
Indications
 ALIF Surgical route
 OLIF Unique challenges
 LLIF Bail out options
 XLIF

 Case example
 World literature on each Approach and what the future lies ahead

4. SURGICALANATOMY :
ANT VS POST APPROACH :
1 . APPROACH ROAD
DESTRUCTIVE VS PHYSIOLOGICAL

5.  a) FUSION AREA


6.  A
Neuro vascular challenges

7. 1

9.  Retroperitoneal approach
 Position
 Expected Complication
 Critical Step



11.  RATIONAL :
 Wolf’s Law
 1.Weight bearing axis
 2. Fusion area and vascularity
 INDICATIONS


12. 1 Retrograde
Ejaculation
Blunt dissection
Peanut vs Cautery
2 Bleeding Microscope
Vascular clips and proximal and
distal control
3 Visceral
injury
Back upVascular /Urology
Surgeon

14.  RATIONAL
 Retroperitoneal
 Anterior to Psos Major
 No lumbar plexus injury
 No need for Neuromonitoring
 Decompression (Indirect) + Stabilization + Deformity Correction
 No Spinal canal entry Torsional stability Height restoration
 No dural injury Fusion rates Larger Cage
 INDICATION

15. 
 Retroperitoneal
 Anterior to Psos Major
 No lumbar plexus injury

 No need for Neuromonitoring

16.  Bare area of disk CT Angio


19.  RATIONAL
 INDICATIONS

20. 1 .Retro peritoneal approach
2 . Position
3. Approach
4 .Expected Complication
5.Absolute Pre requiste

22.  Femoral nerve
 Cage subsidence
 StandaloneXLIF

23. Footprint of the cages

27. 1
2
3 4 5