title: Use of a ventral cervical retractor system for minimal access transforaminal lumbar interbody fusion: technical case report.
abstract: OBJECTIVE
  Interbody lumbar fusion techniques have become increasingly popular because of improved rates of fusion, restoration of disc and foraminal height, and promotion of lordosis. Morbidity has been associated with the exposure for these fusions, potentially leading to muscle injury, trunk muscle weakness, and pain. Minimal access surgery has been advocated to limit the exposure related morbidity. Tubular retractors are available, which allow dilation of the muscle through a small incision. The downside of these dilators is the expense required to use them and a generally cumbersome design, which can limit mobility and medial/lateral exposure.
  
  
  METHODS
  The authors report their experience with a standard ventral cervical retractor system for minimal access transforaminal lumbar interbody fusion. These systems are already owned by the hospital and are familiar to most spine surgeons.
  
  
  RESULTS
  The system is placed through a fascial plane between muscles, eliminating muscle dissection and limiting undue retraction and tissue destruction.
  
  
  CONCLUSIONS
  A standard ventral cervical retractor may be used to perform minimal access transforaminal lumbar interbody fusion. The exposure is as good as or better than tubular retractor systems commercially available. There may be considerable cost savings owing to the elimination of the need for yet another specialized piece of equipment in the operating room. Time may also be saved, as spine surgeons are already adept in the use of such retractors.
authors.affiliation: The Spine Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
mesh_terms: D001863:Bone Screws; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D009984:Orthopedic Fixation Devices; D013123:Spinal Fusion / Q000295:instrumentation*; D013168:Spondylolisthesis / Q000150:complications / Q000601:surgery*; D013581:Synovial Cyst / Q000209:etiology / Q000601:surgery