Sharma Amit K, Kepler Christopher K, Girardi Federico P, Cammisa Frank P, Huang Russel C, Sama Andrew A
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
J Spinal Disord Tech. 2011 Jun;24(4):242-50. doi: 10.1097/BSD.0b013e3181ecf995.
A retrospective review of patients' radiographs and charts.
The various methods of lumbar interbody fusion have been described in the literature. With the development of the lateral lumbar interbody fusion (LLIF) approach, a wider cage can be inserted in the intervertebral space without disrupting the anterior-posterior annulus or longitudinal ligament, with minimal danger to the retroperitoneal structures and the great vessels. There is a paucity of the literature on the radiographic and clinical outcome of this approach.
The purpose of this study is to assess the radiographic change in the coronal and sagittal plane alignment of the lumbar spine after the LLIF approach using XLIF cages (Nuvasive, Inc, San Diego, CA). Radiographic and clinical outcomes, and complications associated with the approach are also described.
A retrospective review of 43 consecutive patients' preoperative, immediate postoperative, and 1-year follow-up radiographs was done. All patients had LLIF procedure performed for lumbar degenerative disc disease, spondylolisthesis, or de novo scoliosis. The radiographic measurements were taken to assess change in the sagittal and coronal plane alignment of the individual instrumented disc level, overall lumbar spine, and lumbar scoliotic curves. The radiographs were also analyzed for fusion at 1 year, end-plate fracture, and other complications. The patients' hospital and clinic charts were reviewed to identify the complications and patient outcomes.
There was a mean correction of 3.7 degrees (P≤0.001) at each instrumented disc level in coronal plane in 87 instrumented levels. Similarly, there was a mean gain of 2.8 degrees (P≤0.001) of lordosis at each level. In 25 patients with lumbar scoliosis (>10 degrees), mean scoliosis angle correction was 10.4 degrees (P=0.001, 43%). There was no significant change in the overall coronal or sagittal plane alignment of the lumbar spine. The most common postoperative complication (25%) was anterior thigh pain, which was transitory in the majority of cases. End-plate breach was common at the instrumented disc levels; however, it was nonprogressive in most of the cases, and did not affect the fusion or alignment at the instrumented levels. The outcome scores were improved significantly at the final follow-up.
The LLIF approach is effective in correcting the coronal plane deformity and in gaining lordosis at individual instrumented levels. They parallelize adjacent end plates to correct the lumbar scoliotic curves. The complications are mostly approach-related and transitory. A larger cohort with long-term follow-up is required to establish the advantages and shortcomings of the procedure.
对患者的X光片和病历进行回顾性研究。
文献中已描述了多种腰椎椎间融合术的方法。随着腰椎侧方椎间融合术（LLIF）方法的发展，可以在不破坏前后纤维环或纵韧带的情况下，将更宽的椎间融合器植入椎间隙，对腹膜后结构和大血管的危险降至最低。关于该方法的影像学和临床结果的文献较少。
本研究的目的是评估使用XLIF椎间融合器（Nuvasive公司，加利福尼亚州圣地亚哥）进行LLIF手术后腰椎在冠状面和矢状面排列的影像学变化。还描述了该方法的影像学和临床结果以及相关并发症。
对43例连续患者的术前、术后即刻及1年随访X光片进行回顾性研究。所有患者均因腰椎退行性椎间盘疾病、椎体滑脱或新发脊柱侧弯接受LLIF手术。进行影像学测量以评估单个植入椎间盘节段、整个腰椎及腰椎侧弯曲线在矢状面和冠状面排列的变化。还对X光片进行分析以评估1年时的融合情况、终板骨折及其他并发症。查阅患者的医院和门诊病历以确定并发症及患者预后。
87个植入节段在冠状面每个植入椎间盘节段平均矫正3.7度（P≤0.001）。同样，每个节段的前凸平均增加2.8度（P≤0.001）。在25例腰椎侧弯（>10度）患者中，平均侧弯角度矫正为10.4度（P = 0.001，43%）。腰椎在整体冠状面或矢状面排列上无显著变化。最常见的术后并发症（25%）是大腿前侧疼痛，大多数情况下为暂时性。终板破裂在植入椎间盘节段很常见；然而，在大多数情况下不会进展，且不影响植入节段的融合或排列。在最终随访时，结果评分显著改善。
LLIF方法在矫正冠状面畸形及增加单个植入节段的前凸方面有效。它们使相邻终板平行以矫正腰椎侧弯曲线。并发症大多与手术方法相关且为暂时性。需要更大规模的队列及长期随访来确定该手术的优缺点。
