Gammal Isaac D, Spivak Jeffrey M, Bendo John A
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
Int J Spine Surg. 2015 Nov 12;9:62. doi: 10.14444/2062. eCollection 2015.
Lateral transpsoas interbody fusion (LTIF) is a minimally invasive technique for achieving lumbar spinal fusion. While it has many advantages over open techniques it carries with it a distinct set of risks, most commonly post-operative ipsilateral thigh pain, weakness and sensory disturbances. It is vital for both the surgeon and patient to understand the risks for and outcomes of injury associated with this procedure. We conducted a systematic review of the literature to evaluate the incidence, risks, and long-term clinical outcomes of post-operative thigh symptoms in patients treated with LTIF.
We conducted a search of MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Collaboration Library, using keywords and MeSH terms, for English-language literature published through September 2014, as well as reference lists from key articles. Studies were then manually filtered to retrieve articles that met inclusion criteria. We were interested in studies that reported postoperative lower extremity symptoms after LTIF, such as pain, weakness and changes in sensation. The strength of evidence was determined based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group (GRADE).
A total of 392 articles were initially retrieved, with 24 ultimately meeting criteria for inclusion. The incidence of any post-operative thigh symptom varied, ranging as high as 60.7%, with 9.3% of patients experiencing a motor deficit related to direct nerve injury. Several studies reported cases of persistent symptoms at 6 months follow up. Additionally, inclusion of the L4-5 disc space and a longer duration of surgery were both identified as risks for developing postoperative thigh symptoms.
The risk of postoperative thigh symptoms after LTIF is high. Thigh pain, paresthesias and weakness were the most commonly reported symptoms. While most patients' symptoms resolved by 6 months follow up, several studies reported patients with symptoms persistent as far as 12 months removed from surgery. Surgery at the L4-5 disc space and longer surgical duration place the patient at greater risk for developing postoperative and long-term thigh symptoms.
腰大肌外侧椎间融合术（LTIF）是一种用于实现腰椎融合的微创技术。虽然它相对于开放技术有许多优势，但也伴随着一系列独特的风险，最常见的是术后同侧大腿疼痛、无力和感觉障碍。对于外科医生和患者来说，了解该手术相关损伤的风险和结果至关重要。我们对文献进行了系统综述，以评估接受LTIF治疗的患者术后大腿症状的发生率、风险和长期临床结果。
我们使用关键词和医学主题词（MeSH）在MEDLINE、EMBASE、CINAHL、Scopus、Web of Science和Cochrane协作图书馆中进行检索，查找截至2014年9月发表的英文文献，以及关键文章的参考文献列表。然后手动筛选研究，以检索符合纳入标准的文章。我们感兴趣的是报告LTIF术后下肢症状的研究，如疼痛、无力和感觉变化。证据强度根据推荐评估、制定和评价工作组（GRADE）概述的原则确定。
最初共检索到392篇文章，最终有24篇符合纳入标准。任何术后大腿症状的发生率各不相同，高达60.7%，9.3%的患者出现与直接神经损伤相关的运动功能障碍。几项研究报告了6个月随访时持续症状的病例。此外，L4 - 5椎间盘间隙的纳入和手术时间延长均被确定为术后出现大腿症状的风险因素。
LTIF术后出现大腿症状的风险很高。大腿疼痛、感觉异常和无力是最常报告的症状。虽然大多数患者的症状在6个月随访时得到缓解，但几项研究报告称，有些患者的症状在手术后12个月仍持续存在。L4 - 5椎间盘间隙手术和更长的手术时间使患者出现术后和长期大腿症状的风险更高。
