*Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY; and †Sektion für Wirbelsäulenchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2013 Nov 1;38(23):E1483-90. doi: 10.1097/BRS.0b013e3182a3d1b4.
Retrospective case series.
To evaluate the proportional trend over time of neurological deficits after lateral lumbar interbody fusion (LLIF) at a single institution.
Because lumbar nerve roots converge to run as the lumbar plexus within or less frequently underneath the posterior part of the psoas muscle, they are prone to iatrogenic damage during the transpsoas approach in LLIF, and adverse postoperative neurological sequelae remain a major concern.
The electronic medical records and office notes of 451 patients who had consecutively undergone LLIF between March 2006 and April 2012 at a single institution were retrospectively reviewed for reports on postoperative neurological deficits.
A total of 293 patients (173 females and 120 males) met the study inclusion criteria and were followed postoperatively for a mean period of 15.4 ± 9.2 months (range: 6-53 mo). The number of included patients who underwent LLIF at our institution was 47 in the years 2006 to 2008 (group A), 155 in 2009 to 2010 (group B), and 91 in 2011 to 2012 (group C). Our data indicate a decreasing proportional trend during the past 6 years for postoperative sensory deficits (SDs), motor deficits (MDs), and anterior thigh pain (TP). The decreasing trends were statistically significant for the proportion of SDs in the immediate postoperative setting (P = 0.018) and close to statistically significant for SDs at last follow-up (P = 0.126), TP immediately after surgery (P = 0.098), and TP at last follow-up (P = 0.136).
To the authors' best knowledge, this study constitutes the largest series of this sort to date, with regard to both sample size and study period. The present data indicate a decreasing proportional trend over time for SDs, MDs, and anterior TP, which can be considered a representation of an institutional learning curve during a 6-year time period of performing LLIF.
回顾性病例系列研究。
评估单中心单侧腰椎椎间融合术（LLIF）后神经功能缺损的时间比例趋势。
由于腰椎神经根在腰大肌的后方或下方汇聚成腰丛，因此在 LLIF 经椎间孔入路时易发生医源性损伤，术后不良神经后遗症仍然是一个主要关注点。
回顾性分析 2006 年 3 月至 2012 年 4 月期间在单中心连续行 LLIF 的 451 例患者的电子病历和门诊病历，报告术后神经功能缺损情况。
共有 293 例患者（173 例女性和 120 例男性）符合研究纳入标准，术后平均随访 15.4 ± 9.2 个月（范围：6-53 个月）。我院 2006 年至 2008 年（A 组）行 LLIF 的患者为 47 例，2009 年至 2010 年（B 组）为 155 例，2011 年至 2012 年（C 组）为 91 例。我们的数据表明，在过去 6 年中，术后感觉缺陷（SD）、运动缺陷（MD）和大腿前痛（TP）的比例呈下降趋势。术后即刻 SD 比例的下降趋势具有统计学意义（P = 0.018），而末次随访时 SD 的下降趋势接近统计学意义（P = 0.126），术后即刻 TP（P = 0.098）和末次随访时 TP（P = 0.136）。
据作者所知，这是迄今为止关于样本量和研究时间的此类研究中最大的系列研究。本研究数据表明，SD、MD 和前 TP 的比例随时间呈下降趋势，这可以被认为是在 6 年时间内进行 LLIF 的机构学习曲线的代表。
