Formica Matteo, Zanirato Andrea, Cavagnaro Luca, Basso Marco, Divano Stefano, Felli Lamberto, Formica Carlo
Clinica Ortopedica-IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
GSpine4-IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, MI, Italy.
Eur Spine J. 2017 Oct;26(Suppl 4):464-470. doi: 10.1007/s00586-017-5115-6. Epub 2017 May 9.
To evaluate clinical outcomes and complications of extreme lumbar interbody fusion (XLIF) in spinal revision surgery comparing our data with the available literature evidence about other fusion techniques.
Retrospective analysis of patients underwent revision surgery with XLIF as interbody fusion technique. Demographic, comorbidity, surgical data, clinical results, and intraoperative and postoperative complications were recorded.
36 patients, with a minimum follow-up of 28 ± 11.5 months, were included in the analysis. 41 levels were fused with XLIF. The mean number of previous spine surgery was 1.5 ± 0.7. Mean improvement in back pain and leg pain on VAS was 5.6 ± 1.4 (p < 0.01) and 3.5 ± 2 (p < 0.01), respectively. Mean improvement in the ODI score was 30.3 ± 7.3 (p < 0.01). 1 vertebral endplate fracture during interbody space preparation was reported during lateral approach. 5 patients (13.8%) complained quadriceps weakness and anterior thigh hypoesthesia fully recovered after 3 months from surgery, and in one case, a transient contralateral radiculopathy was observed. No implant failure was detected at final follow-up.
XLIF is a reasonably safe and effective fusion technique in revision surgery that allows valid arthrodesis avoiding scarred tissue created by previous surgical approaches. Especially, XLIF reduces the risk of nerve root lesions, postoperative radiculitis, and durotomies compared to posterior fusion techniques.
评估极外侧腰椎椎间融合术（XLIF）在脊柱翻修手术中的临床疗效和并发症，并将我们的数据与其他融合技术的现有文献证据进行比较。
对接受XLIF椎间融合术翻修手术的患者进行回顾性分析。记录患者的人口统计学、合并症、手术数据、临床结果以及术中及术后并发症。
36例患者纳入分析，最短随访时间为28±11.5个月。共对41个节段进行了XLIF融合。既往脊柱手术的平均次数为1.5±0.7次。视觉模拟评分法（VAS）评估的背痛和腿痛平均改善分别为5.6±1.4（p<0.01）和3.5±2（p<0.01）。腰椎功能障碍指数（ODI）评分平均改善30.3±7.3（p<0.01）。外侧入路椎间间隙准备过程中报告1例椎体终板骨折。5例患者（13.8%）主诉股四头肌无力和大腿前部感觉减退，术后3个月完全恢复，1例患者出现短暂对侧神经根病。末次随访时未发现内植物失败。
XLIF在翻修手术中是一种相对安全有效的融合技术，可实现有效的关节融合，避免既往手术入路造成的瘢痕组织。特别是，与后路融合技术相比，XLIF降低了神经根损伤、术后神经根炎和硬脊膜切开的风险。
