腰椎側方椎体間固定術（XLIFおよびOLIF）—適応，X線透視ガイダンス・3D-CT脊椎ナビゲーション手技，合併症回避のための安全な手術の実際

Lateral Lumbar Interbody Fusion（XLIF ＆ OLIF）:Indications, X-ray Fluoroscopy-guided and 3D-CT Spinal Navigation Techniques, and Safe Surgical Practices to Prevent Complications

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・腰椎側方椎体間固定術には，大腰筋経由のXLIFと大腰筋前縁からアプローチするOLIFの2法があり，後方固定法に代わる低侵襲手術である．

・両者の適応と非適応，X線透視ガイダンスと3D-CT脊椎ナビゲーションによる手法および合併症回避のための安全な手技を解説する．

・腰椎神経叢障害，大血管障害，尿管損傷，腸管損傷など，重大な合併症が報告されており，入念な術前計画が必要である．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Lateral lumbar interbody fusion（LLIF）, including extreme lateral interbody fusion（XLIF）and oblique lateral interbody fusion（OLIF）, constitute a treatment option for many lumbar disorders that predominantly cause degenerative disc disease. LLIF is beneficial for managing conditions, such as lumbar spondylolisthesis, degenerative disc disease, and adult spinal deformities. LLIF is preferred for enabling indirect decompression of the spinal canal and nerve root foramen, without inducing immediate postoperative damage to the peri-vertebral tissues. To minimize the risk of lumbosacral plexopathy, neuromonitoring and X-ray fluoroscopy are routinely used, and can confer significant radiation exposure on surgeons and surgical staff. Intraoperative imaging-guided spinal navigation during LLIF increases accuracy and reduces radiation exposure. Nonetheless, the risk of serious LLIF-associated complications, such as lumbosacral plexopathy, vascular problems, ureteral damage, and intestinal damage, warrant a precise preoperative plan. To improve the operative safety of LLIF, this report elucidates the procedural details of XLIF and OLIF and highlights the potential pitfalls of LLIF.