Frantzides Constantine T, Zeni Tallal M, Phillips Frank M, Mathur Sameer, Zografakis John G, Moore Ronald M, Laguna Luis E
Minimally Invasive Surgery Center, Department of Surgery, Evanston Northwestern Healthcare and Northwestern University, Evanston, Illinois 60201, USA.
JSLS. 2006 Oct-Dec;10(4):488-92.
We evaluated our experience with laparoscopic L5-S1 anterior lumbar interbody fusion (ALIF).
This represents a retrospective analysis of consecutive patients who underwent L5-S1 laparoscopic ALIF between February 1998 and August 2003.
Twenty-eight patients underwent L5-S1 LAIF (15 males and 13 females). The mean age was 43 years (range, 26 to 67). Mean operative time was 225 minutes (range, 137 to 309 minutes). No conversions to an open procedure were necessary. Twenty-four (85.7%) patients underwent successful bilateral cage placement. Four patients (14.3%) in whom only a single cage could be placed underwent supplementary posterior pedicle screw placement. Mean length of stay (LOS) was 4.1 days (range, 2-to 15). Two patients underwent reoperation subacutely secondary to symptomatic lateral displacement of the cage. One patient developed radiculopathy 6 months postoperatively and required reoperation. One patient developed a small bowel obstruction secondary to adhesions to the cage requiring laparoscopic reoperation. Fusion was achieved in all patients. Visual analogue scale scores for back pain were significantly improved from 8.6+/-0.8 to 2.8+/-0.8 (P<0.0001) at 1 year.
L5-S1 LAIF is feasible and safe with all the advantages of minimally invasive surgery. Fusion rates and pain improvement were comparable to those with an open repair.
我们评估了腹腔镜下L5 - S1前路腰椎椎间融合术（ALIF）的经验。
这是一项对1998年2月至2003年8月期间连续接受L5 - S1腹腔镜ALIF手术患者的回顾性分析。
28例患者接受了L5 - S1 LAIF手术（15例男性，13例女性）。平均年龄为43岁（范围26至67岁）。平均手术时间为225分钟（范围137至309分钟）。无需转为开放手术。24例（85.7%）患者成功进行了双侧椎间融合器置入。4例（14.3%）仅能置入单个椎间融合器的患者接受了补充后路椎弓根螺钉置入。平均住院时间（LOS）为4.1天（范围2至15天）。2例患者因椎间融合器出现有症状的侧向移位而在亚急性期接受了再次手术。1例患者术后6个月出现神经根病，需要再次手术。1例患者因与椎间融合器粘连继发小肠梗阻，需要腹腔镜再次手术。所有患者均实现了融合。背痛的视觉模拟评分在1年时从8.6±0.8显著改善至2.8±0.8（P<0.0001）。
L5 - S1 LAIF可行且安全，具有微创手术的所有优点。融合率和疼痛改善情况与开放修复相当。
