Anterior extraperitoneal discectomy

Anterior transperitoneal discectomy, the anterior and lateral discs are more clearly revealed, and the adjacent two intervertebral discs can be removed at the same time, and it is beneficial to perform anterior fusion of the lower limbs. Treatment of diseases: lumbar disc herniation Indication Anterior extraperitoneal discectomy is applicable to: 1. The central type of intervertebral disc protrudes and has huge protrusions, and those who have difficulty in removing the posterior road. 2. Disc herniation after posterior nucleus pulposus removal, disc herniation recurrence. 3. Disc herniation combined with lumbar degenerative or isthmic collapse with slip. Preoperative preparation 1. The diagnosis must be clear, including the segment and side of the disc herniation, whether it is a single segment or multiple segments. 2. Accurate positioning, X-ray film positioning should be taken before surgery, especially those with transitional vertebra deformity, and those with lumbar 4 or more segments are more necessary. 3. Clean the enema 1 day before and during the morning. Surgical procedure Incision Usually take the left oblique incision (the inverted "eight" incision with tuberculosis lesion removal) or the left median incision, 12 ~ 14cm long. 2. Reveal the disc Taking the left oblique incision as an example, the skin and subcutaneous tissue were cut, the aponeurosis of the external oblique muscle was cut, and the transverse abdominis muscle was separated and separated. The extraperitoneal fat and peritoneum are exposed and protected by a large gauze pad. The blunt dissection along the outer side of the peritoneum and the reflexed part is gradually removed and gradually moved toward the center. It can be seen that the ureter moves from top to bottom and gently pushes to the right side, and the inferior vena cava is located inside the ureter and is protected. The lumbar 5~1 intervertebral disc is located at the bifurcation of the abdominal aorta and inferior vena cava, and the lumbar 4 and 5 intervertebral discs are located above it. The lumbosacral angle is used as an anatomical landmark. After clear positioning, the connective tissue of the vertebral body and the intervertebral disc is carefully separated on the left side, and the lumbar artery and vein can be ligated to expand the exposure range. 3. Nucleus removal The discus of the diseased segment was fully exposed, and the fiber ring was cut into L shape with a sharp knife and slightly peeled off. The nucleus pulposus is slowly inserted into it, and the jaws are opened, and the nucleus pulposus is removed by clamping. According to the direction of the disc herniation determined before surgery, the nucleus pulposus is gradually deepened and adjusted.