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Updated: Oct 15, 2025
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Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
698
Surface landmarks for anterior lumbar access: is fluoroscopy necessary?
Matthew H Claydon1, Jordan P Laggoune2, Thomas A Wells-Quinn2
1Epworth Hospital, 89 Bridge Road, Richmond, Vic 3121, Melbourne, Australia; The Alfred Hospital, 55 Commercial Road, Prahran, Vic 3004, Melbourne, Australia.
Summary
Anterior lumbar fusion surgery is rising, but precise incision guidelines are lacking. This study found surface landmarks have significant variability, making intraoperative fluoroscopy essential for accurate surgical planning in anterior lumbar access surgery.
Area of Science:
- Spine surgery
- Anatomy
- Surgical access
Background:
- Anterior lumbar fusion surgery is increasing annually in the US.
- Precise anatomic guidelines for anterior access incision sites are limited.
Purpose of the Study:
- To compare anterior surface landmarks with fluoroscopic levels for L4/L5 and L5/S1.
- To develop a guide for surgical incision sites in anterior lumbar access surgery.
Main Methods:
- Prospective observational cohort study of 165 patients undergoing anterior lumbar interbody fusion (ALIF) or total disk replacement (TDR).
- Measured distance from symphysis pubis to disk level (SD) and umbilicus (SU), calculating the SD/SU ratio.
- Analyzed variability using t-tests and R-squared tests.
Main Results:
- Significant variability in SD distances (≥9.5 cm) was observed at both L5/S1 and L4/L5 levels.
- SD/SU ratios showed less variability than SD distance alone but remained substantial.
- No significant difference in SD/SU ratios between sexes; ratios were lower in overweight/obese patients.
Conclusions:
- Surface landmarks for anterior lumbar access surgery exhibit clinically important variability.
- SD/SU ratios offer improved consistency over SD distance but are not definitive.
- Intraoperative fluoroscopy is mandatory for accurate surgical incision planning in anterior lumbar access procedures.
