Department of Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles 90048, USA.
J Neurosurg Spine. 2011 Jul;15(1):92-6. doi: 10.3171/2011.3.SPINE10425. Epub 2011 Apr 8.
The lateral transpsoas approach for lumbar interbody fusion is a minimal access technique that has been used by some to treat lumbar degenerative conditions, including degenerative scoliosis. Few studies, however, have analyzed its effect on coronal and sagittal plane correction, and no study has compared changes in segmental, regional, and global coronal and sagittal alignment after this technique. The object of this study was to determine changes in sagittal and coronal plane alignment occurring after direct lateral interbody fusion (DLIF).
The authors performed a review of the radiographic records of 36 patients with lumbar degenerative disease treated with the DLIF technique. Thirty-five patients underwent supplemental posterior fixation to maintain correction. Preoperative and postoperative standing anteroposterior and lateral lumbar radiographs were obtained in all patients for measurement of segmental and regional coronal and sagittal Cobb angles. Standing anteroposterior and lateral 36-in radiographs were also obtained in 23 patients for measurement of global coronal (center sacral vertebral line) and sagittal (C-7 plumb line) balance.
The mean coronal segmental Cobb angle was 4.5° preoperatively, and it was 1.5° postoperatively (p < 0.0001). The mean pre- and postoperative regional lumbar coronal Cobb angles were 7.6° and 3.6°, respectively (p = 0.0001). In 8 patients with degenerative scoliosis, the mean pre- and postoperative regional lumbar coronal Cobb angles were 21.4° and 9.7°, respectively (p = 0.0004). The mean global coronal alignment was 19.1 mm preoperatively, and it was 12.5 mm postoperatively (p < 0.05). In the sagittal plane, the mean segmental Cobb angle measured -5.3° preoperatively and -8.2° postoperatively (p < 0.0001). The mean pre- and postoperative regional lumbar lordoses were 42.1° and 46.2°, respectively (p > 0.05). The mean global sagittal alignment was 41.5 mm preoperatively and 42.4 mm postoperatively (p = 0.7). The average clinical follow-up was 21 months in 21 patients. The mean pre- and postoperative visual analog scale scores were 7.7 and 2.9, respectively (p < 0.0001). The mean pre- and postoperative Oswestry Disability Indices were 43 and 21, respectively (p < 0.0001).
Direct lateral interbody fusion significantly improves segmental, regional, and global coronal plane alignment in patients with degenerative lumbar disease. Although DLIF increases the segmental sagittal Cobb angle at the level of instrumentation, it does not improve regional lumbar lordosis or global sagittal alignment.
腰椎椎间融合的侧方经椎间孔入路是一种微创技术，一些医生用它来治疗腰椎退行性疾病，包括退行性脊柱侧凸。然而，很少有研究分析其对冠状面和矢状面矫正的影响，也没有研究比较该技术后节段、区域和整体冠状面和矢状面排列的变化。本研究的目的是确定直接侧方椎间融合（DLIF）后发生的矢状面和冠状面排列的变化。
作者对 36 例接受 DLIF 技术治疗的腰椎退行性疾病患者的影像学记录进行了回顾性分析。35 例患者接受了辅助后路固定以维持矫正。所有患者均获得术前和术后站立前后位和侧位腰椎 X 线片，以测量节段和区域冠状面和矢状面 Cobb 角。23 例患者还获得了站立前后位和侧位 36 英寸 X 线片，以测量整体冠状面（正中骶椎线）和矢状面（C-7 铅垂线）平衡。
术前平均冠状节段 Cobb 角为 4.5°，术后为 1.5°（p<0.0001）。术前和术后区域腰椎冠状 Cobb 角分别为 7.6°和 3.6°（p=0.0001）。在 8 例退行性脊柱侧凸患者中，术前和术后区域腰椎冠状 Cobb 角分别为 21.4°和 9.7°（p=0.0004）。术前平均整体冠状面排列为 19.1mm，术后为 12.5mm（p<0.05）。在矢状面，术前平均节段 Cobb 角为-5.3°，术后为-8.2°（p<0.0001）。术前和术后区域腰椎前凸分别为 42.1°和 46.2°（p>0.05）。术前平均整体矢状面排列为 41.5mm，术后为 42.4mm（p=0.7）。21 例患者的平均临床随访时间为 21 个月。术前和术后平均视觉模拟评分分别为 7.7 和 2.9（p<0.0001）。术前和术后 Oswestry 功能障碍指数分别为 43 和 21（p<0.0001）。
直接侧方椎间融合术可显著改善退行性腰椎疾病患者的节段、区域和整体冠状面排列。虽然 DLIF 增加了器械水平的节段矢状 Cobb 角，但它不能改善区域腰椎前凸或整体矢状面排列。
