Laparoscopic exposure of lumbar interbody fusion

Treatment of diseases: lumbar spondylolisthesis Indication Transabdominal laparoscopic lumbar interbody fusion for: 1. Simple lumbar intervertebral space stenosis without posterior decompression. 2. Lumbar pedicle isthmus is not connected. 3.I degree lumbar spondylolisthesis. 4. Symptoms recurred after posterior nucleus pulposus removal. 5. Posterior fusion surgery failed. 6. There is no lumbar spinal stenosis, no need for spinal canal decompression. Contraindications 1. Severe osteoporosis. 2. Vertebral bone destruction disease (lumbar tuberculosis, tumor). 3. History of abdominal surgery, peritoneal adhesions. 4. Inflammation of the abdominal organs, peritoneal tuberculosis. Surgical procedure 1. Insert the Verres needle in the midline of the umbilicus and inflate the abdominal cavity with 15mmHg. 2. Make 10mm and 5mm openings in the umbilicus midline, right lower abdomen, and left lower abdomen, respectively, in order to place the retractor, laparoscopic hemostatic clip, implant Cage casing, and catheter operation. 3. Expose the waist 5 or 1 disc. The small intestine was dissected to the root of the mesentery and pulled to the pelvis. The assistant pulled the sigmoid colon to the left side to the mesentery. 4. Under the visual screen, the incision is correct. The peritoneum is cut by the cautery at the waist 5 or the intervertebral disc annulus. The longitudinal incision is performed, and the dental ablator is bluntly dissected to separate and remove the adipose tissue. Free autonomic nerves, large resection. 5. When you see the blood vessels in the sputum, you can reveal the annulus fibrosus, separate the fibrous ring from inflammation and adhesion, insert the clip, and cut off the blood vessels in the sputum. 6. Bluntly separate the left common iliac vein located on the left side of the annulus fibrosus (ie, the Cage site). 7. Expose the anterior annulus fibrosus and mark it on the pre-positioned Cage. 8. Under the anterior, posterior, and lateral monitoring, the device is placed in the middle of the fibrous portion through the abdominal wall, and the exact position in the coronal and sagittal planes is determined to be in the middle of the annulus. 9. Drill holes in the ring at the mark into the intervertebral space. 10. Insert the operating cannula vertically into the 2 cm midline of the pubic symphysis. 11. Insert the Cage operating tube into the abdominal cavity and use a "plug" to enlarge the hole to restore the height of the intervertebral space. 12. Protect and distract the left common iliac vein, and insert the fixed piece into the left annulus. 13. Review operation. Complete the right Cage implant surgery. complication 1. The abdominal cavity is moved upwards to affect the heart function or hypoxia, tight monitoring, abnormal treatment in time. 2. A few patients have retrograde ejaculation after surgery, usually gradually recover after 2 months. 3. Cut off the sympathetic nerve: affect the vasomotor contraction, the left lower limb "warm leg", generally gradually improved about 3 months after surgery. 4. Postoperative adhesive intestinal obstruction, caused by adhesion between the small intestine and the posterior wall of the abdomen.