title: Digitalized design of extraforaminal lumbar interbody fusion: a computer-based simulation and cadaveric study.
abstract: OBJECTIVE
  This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study.
  
  
  METHODS
  The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers.
  
  
  RESULTS
  The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8-9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement.
  
  
  CONCLUSIONS
  According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Mingjie
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zeng
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Song
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Yingchao
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Zeqing
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tan
mesh_terms: D000328:Adult; D001863:Bone Screws; D002102:Cadaver; D003198:Computer Simulation; D017076:Computer-Aided Design; D006801:Humans; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000601:surgery*; D008161:Lumbosacral Region / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008953:Models, Anatomic; D013123:Spinal Fusion / Q000379:methods*