Hrabalek Lumir, Adamus Milan, Gryga Adolf, Wanek Tomas, Tucek Peter
Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014;158(1):127-32. doi: 10.5507/bp.2012.079. Epub 2012 Sep 5.
The aim of this study was to compare the complication rate of traditional minimally invasive anterior with the new minimally invasive lateral trans-psoatic retroperitoneal approaches to the intervertebral discs at levels T12-L5.
A review of all cases of minimally invasive anterior (ALIF) and lateral (XLIF) intervertebral disc surgery at levels T12-L5, treated at the Department of Neurosurgery from January 1996 to September 2011. The ALIF group consisted of 120 and the XLIF group consisted of 88 patients. Preoperative diagnoses were: degenerative disc disease, failed back surgery syndrome, spondylolisthesis, retrolisthesis and posttraumatic disc injury. The surgical steps are described. All surgical intraoperative and postoperative complications directly related to the spinal surgery were prospectively documented. The outcome measure was rate of complications.
In the ALIF group there were no major complications, only 35 minor intra- and postoperative complications in 32 patients (26.6%). The main complication was lumbar post-sympathectomy syndrome in 19 patients (15.8%). In the XLIF group there were 26 complications in 22 patients (25%). One major intraoperative complication was partial and transient injury to the L5 nerve root (1.1%). There were 25 minor postoperative complications in the XLIF group in 21 patients (23.9%), mainly transient pain of the left groin or anterior thigh in 11 patients (12.5%) or numbness in the same dermatomas in 9 patients (10.2%). Statistically there was no difference between the ALIF and XLIF groups in complication rate.
Anterolateral and lateral retroperitoneal minimally invasive approaches to levels T12-L5 disc spaces are safe procedures with only minor complications and one exception. The rate of complications was similar in both groups. In the case of ALIF, the particular complication was post-sympathectomy syndrome. The main complication of XLIF was transient nerve root injury in one patient due to underestimation of the procedure in the outset. Intraoperative neuromonitoring during XLIF surgery is fully recommended.
本研究旨在比较传统微创前路与新型微创经腰大肌外侧腹膜后入路治疗胸12至腰5椎间盘的并发症发生率。
回顾1996年1月至2011年9月在神经外科接受治疗的所有胸12至腰5节段微创前路（ALIF）和外侧（XLIF）椎间盘手术病例。ALIF组有120例患者，XLIF组有88例患者。术前诊断包括：椎间盘退变、腰椎手术失败综合征、椎体滑脱、椎体后移和创伤后椎间盘损伤。描述了手术步骤。前瞻性记录所有与脊柱手术直接相关的手术中及术后并发症。观察指标为并发症发生率。
ALIF组无严重并发症，仅32例患者出现35例轻微术中及术后并发症（26.6%）。主要并发症为19例患者（15.8%）出现腰交感神经切除术后综合征。XLIF组22例患者出现26例并发症（25%）。1例主要术中并发症为L5神经根部分短暂损伤（1.1%）。XLIF组21例患者出现25例轻微术后并发症（23.9%），主要为11例患者（12.5%）出现左腹股沟或大腿前侧短暂疼痛，9例患者（10.2%）出现相同皮节麻木。统计学上，ALIF组和XLIF组并发症发生率无差异。
胸12至腰5椎间盘间隙的前外侧和外侧腹膜后微创入路是安全的手术方式，仅有轻微并发症及1例例外情况。两组并发症发生率相似。对于ALIF，特殊并发症是交感神经切除术后综合征。XLIF的主要并发症是1例患者因手术初期对手术估计不足导致短暂神经根损伤。强烈推荐在XLIF手术中进行术中神经监测。
