Department of Neurosurgery, University of California-Davis, Sacramento, California, USA.
Neurosurg Focus. 2011 Oct;31(4):E4. doi: 10.3171/2011.7.FOCUS11137.
Recently, the minimally invasive, lateral retroperitoneal, transpsoas approach to the thoracolumbar spinal column has been described by various authors. This is known as the minimally invasive lateral lumbar interbody fusion. The purpose of this study is to elucidate the approach-related morbidity associated with the minimally invasive transpsoas approach to the lumbar spine. To date, there have been only a couple of reports regarding the morbidity of the transpsoas muscle approach.
A nonrandomized, prospective study utilizing a self-reported patient questionnaire was conducted between January 2006 and June 2008 at Northwestern University. Data were collected in 53 patients with a follow-up period ranging from 6 months to 3.5 years. Only 2 patients were lost to follow-up.
Thirty-six percent (19 of 53) of patients reported subjective hip flexor weakness, 25% (13 of 53) anterior thigh numbness, and 23% (12 of 53) anterior thigh pain. However, 84% of the 19 patients reported complete resolution of their subjective hip flexor weakness by 6 months, and most experienced improved strength by 8 weeks. Of those reporting anterior thigh numbness and pain, 69% and 75% improved to their baseline function by the 6-month follow-up evaluations, respectively. All patients with self-reported subjective hip flexor weakness underwent examinations during subsequent clinic visits after surgery; however, these examinations did not confirm a motor deficit less than Grade 5. Subset analysis showed that the L3-4 and L4-5 levels were most often affected.
The minimally invasive, transpsoas muscle approach to the lumbar spine has a number of advantages. The data show that a percentage of the patients undergoing the transpsoas approach will have temporary sensory and motor symptoms related to this approach. The majority of the symptoms are thought to be related to psoas muscle inflammation and/or stretch injury to the genitofemoral nerve due to the surgical corridor traversed during the operation. No major injuries to the lumbar plexus were encountered. It is important to educate patients prior to surgery of the possibility of these largely transient symptoms.
最近，各种作者已经描述了微创、侧后腹膜、经椎间孔入路治疗胸腰椎脊柱。这被称为微创侧方腰椎椎间融合术。本研究的目的是阐明微创经椎间孔入路治疗腰椎相关的围手术期发病率。迄今为止，只有少数几篇关于经多裂肌肌间隙入路发病率的报道。
在 2006 年 1 月至 2008 年 6 月期间，在西北大学进行了一项非随机、前瞻性研究，采用自我报告的患者问卷调查。在 53 例患者中收集数据，随访时间从 6 个月到 3.5 年不等。只有 2 例患者失访。
36%（53 例中有 19 例）的患者报告有主观髋关节屈肌无力，25%（53 例中有 13 例）有前大腿麻木，23%（53 例中有 12 例）有前大腿疼痛。然而，19 例患者中有 84%在 6 个月时报告完全缓解主观髋关节屈肌无力，并且大多数在 8 周时经历了肌力的改善。在前大腿麻木和疼痛的患者中，69%和 75%分别在 6 个月的随访评估中恢复到基线功能。所有报告有主观髋关节屈肌无力的患者在手术后的后续门诊就诊时都接受了检查；然而，这些检查并未确认运动功能障碍小于 5 级。亚组分析显示，L3-4 和 L4-5 水平最常受影响。
微创、经多裂肌肌间隙入路治疗腰椎有许多优点。数据显示，接受经多裂肌肌间隙入路的患者中，有一定比例的患者会出现与该入路相关的暂时性感觉和运动症状。大多数症状被认为与手术过程中穿过的手术通道引起的多裂肌炎症和/或股神经伸展损伤有关。未发现腰丛神经的主要损伤。在手术前向患者说明这些主要是暂时的症状是很重要的。
