Schonauer Claudio, Stienen Martin Nikolaus, Gautschi Oliver Pascal, Schaller Karl, Tessitore Enrico
Department of Neurosurgery, Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
World Neurosurg. 2017 Jul;103:869-875.e3. doi: 10.1016/j.wneu.2017.04.110. Epub 2017 Apr 26.
The extreme lateral lumbar interbody fusion (XLIF) technique is safe and effective; however, the deep and tight surgical corridor makes visual identification of important landmark structures, as well as sufficient endplate and contralateral preparation, challenging. In the present study, we analyzed the safety and feasibility of endoscope-assisted (EA) XLIF procedures.
This was a retrospective single-center study on consecutive patients undergoing XLIF procedures between February 2014 and July 2016. EA-XLIF and conventional XLIF (c-XLIF) procedures were compared in terms of the duration of surgery, estimated blood loss (EBL), perioperative and postoperative complications, and postoperative outcomes.
A total of 41 patients (mean age, 66.7 years ± 10.0 years; 22 males [53.7%]) underwent a XLIF procedure, including 6 (14.6%) who underwent EA-XLIF. EA-XLIF did not increase the duration of surgery or EBL. No perioperative or postoperative complications were observed in any of the EA-XLIF procedures. Clinical and radiologic outcomes at 6 weeks postsurgery and at the last follow-up (mean, 8.0 ± 5.8 months postsurgery) were similar for patients in the EA-XLIF and c-XLIF groups. The EA-XLIF technique was considered particularly helpful for checking the lumbar plexus anatomy on the psoas surface, identifying the relationship between the peritoneum and the psoas muscle, positioning the shim into the disc space, removing the disk, and checking the quality of contralateral release and endplate preparation.
The EA-XLIF technique is safe and may be considered as an adjunct procedure, offering improved visualization to guide the surgeon in key steps of the XLIF procedure.
腰椎极外侧椎间融合术（XLIF）技术安全有效；然而，手术通道深且狭窄，使得重要标志性结构的视觉识别以及足够的终板处理和对侧准备工作具有挑战性。在本研究中，我们分析了内镜辅助（EA）XLIF手术的安全性和可行性。
这是一项对2014年2月至2016年7月期间连续接受XLIF手术患者的回顾性单中心研究。比较了EA-XLIF和传统XLIF（c-XLIF）手术在手术时间、估计失血量（EBL）、围手术期和术后并发症以及术后结果方面的差异。
共有41例患者（平均年龄66.7岁±10.0岁；男性22例[53.7%]）接受了XLIF手术，其中6例（14.6%）接受了EA-XLIF手术。EA-XLIF并未增加手术时间或EBL。在任何EA-XLIF手术中均未观察到围手术期或术后并发症。EA-XLIF组和c-XLIF组患者在术后6周和最后随访时（平均术后8.0±5.8个月）的临床和影像学结果相似。EA-XLIF技术被认为在检查腰大肌表面的腰丛解剖结构、确定腹膜与腰大肌之间的关系、将垫片置入椎间盘间隙、摘除椎间盘以及检查对侧松解和终板准备质量方面特别有帮助。
EA-XLIF技术是安全的，可被视为一种辅助手术，能改善可视化效果，在XLIF手术的关键步骤中为外科医生提供指导。
