Rodgers William B, Cox Curtis S, Gerber Edward J
Spine Midwest, Inc., Mary's Medical Plaza Ste, Jefferson City, MO 65101, USA.
J Spinal Disord Tech. 2010 Aug;23(6):393-7. doi: 10.1097/BSD.0b013e3181b31729.
A retrospective review of prospective data of all patients undergoing extreme lateral interbody fusion (XLIF) for degenerative disease of the lumbar and thoracic spine.
To compare between obese and nonobese patients, the incidence of early complications and predictive factors affecting complication rate.
XLIF is a 90-degree off midline approach that allows for large graft placement, excellent disk height restoration, and indirect decompression at the stenotic motion segment. As the psoas muscle is traversed, the lumbosacral plexus is protected by the use of automated electrophysiology through dynamic discrete evoked electromyogram thresholding. Exposure is achieved with an expandable split-blade retractor, which allows for direct illuminated visualization facilitating discectomy and complete anterior column stabilization by using a large load-bearing implant that rests on the dense ring apophysis bilaterally.
A retrospective chart review of a prospectively compiled database of all patients treated with the XLIF procedure between October 2006 and July 2008 was completed. Early complications were defined as any adverse events occurring within the first 3 months of the index procedure. The National Institute of Health Guidelines for defining obesity relating to body mass index were used.
Out of 432 patients, 313 have complete data: 156 obese, 157 nonobese. The ages, comorbidities, earlier surgeries, and diagnoses were equivalent. There were no transfusions and no infections. Complications were minimal and about the same in each group.
Unlike traditional open lumbar fusion procedures, minimally invasive surgery (XLIF) has no greater risk of complication in the obese patient.
对所有因腰椎和胸椎退行性疾病接受极外侧椎间融合术（XLIF）的患者的前瞻性数据进行回顾性分析。
比较肥胖患者与非肥胖患者早期并发症的发生率以及影响并发症发生率的预测因素。
XLIF是一种偏离中线90度的手术入路，可实现较大的植骨置入、良好的椎间隙高度恢复以及对狭窄运动节段的间接减压。由于要穿过腰大肌，通过动态离散诱发肌电图阈值化使用自动电生理技术来保护腰骶丛。使用可扩张的劈开式叶片牵开器来实现暴露，该牵开器可提供直接照明视野，便于进行椎间盘切除术，并通过使用双侧置于致密环状骨突上的大型承重植入物来完成前柱稳定。
对2006年10月至2008年7月期间接受XLIF手术的所有患者的前瞻性汇编数据库进行回顾性图表分析。早期并发症定义为在初次手术的前3个月内发生的任何不良事件。采用美国国立卫生研究院关于根据体重指数定义肥胖的指南。
432例患者中，313例有完整数据：156例肥胖，157例非肥胖。年龄、合并症、既往手术史和诊断情况相当。无输血及感染情况。并发症极少，且每组情况大致相同。
与传统的开放性腰椎融合手术不同，微创手术（XLIF）在肥胖患者中发生并发症的风险并不更高。
