Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea.
Eur Spine J. 2017 Nov;26(11):2797-2803. doi: 10.1007/s00586-017-5176-6. Epub 2017 Jun 22.
Oblique lateral interbody fusion (OLIF) L5-S1 is essentially to perform an anterior lumbar interbody fusion (ALIF) in the lateral position. Because the surgical procedures are performed "obliquely" over the left common iliac vein (LCIV), ensuring that the vein is protected which is particularly important. We aimed to evaluate the configuration of LCIV and its risk of mobilization during anterior approach at L5-S1 segment.
This study involved 65 consecutive patients who underwent anterior lumbar fusion (ALIF, n = 39; OLIF, n = 26) at the L5-S1 segment. Three independent examiners evaluated the configuration of the LCIV at the L5-S1 disc on axial magnetic resonance images of the lumbar spine. The LCIV was categorized into three types according to the difficulty of mobilization: type I (no requirement for mobilization; LCIV runs laterally for more than two-thirds of the length of the left side of the L5-S1 disc), type II (easy mobilization; LCIV obstructs the L5-S1 disc space, but the perivascular adipose tissue is present under the LCIV), and type III (potentially difficult mobilization; no perivascular adipose tissue under the LCIV). The patient records were reviewed for vascular complications.
There were 21 men and 44 women in this study, with a mean age of 63.4 years (range 19-83 years). Type I LCIV configuration was found in 32 (49.2%) patients, type II in 18 (27.7%), and type III in 15 (23.1%). There were 7 (10.8%) patients with LCIV injury (type I, n = 0; type II, n = 2; type III, n = 5) (P = 0.003). Intraobserver reliability for the LCIV classification ranged from substantial to excellent, and interobserver reliability ranged from moderate to excellent.
Preoperative evaluation for anterior approach to the L5-S1 segment should take account of the LCIV position, as well as the difficulty of its mobilization. The type III LCIV configuration showed a high rate of vascular injury.
斜外侧腰椎间融合术（OLIF）L5-S1 本质上是在侧位进行前路腰椎间融合术（ALIF）。由于手术是在左侧髂总静脉（LCIV）上方“斜行”进行的，因此确保保护静脉非常重要。我们旨在评估 L5-S1 节段前路手术中 LCIV 的形态及其在移动过程中的风险。
本研究纳入了 65 例连续接受前路腰椎融合术（ALIF，n=39；OLIF，n=26）的患者。3 位独立的检查者评估了腰椎脊柱轴向磁共振图像上 L5-S1 椎间盘处 LCIV 的形态。根据移动难度将 LCIV 分为 3 型：I 型（无需移动；LCIV 在 L5-S1 椎间盘左侧三分之二以上长度处走行）、II 型（易移动；LCIV 阻塞 L5-S1 椎间盘间隙，但 LCIV 下方有血管周围脂肪组织）和 III 型（可能难以移动；LCIV 下方无血管周围脂肪组织）。回顾患者记录以评估血管并发症。
本研究共纳入 21 名男性和 44 名女性患者，平均年龄为 63.4 岁（19-83 岁）。32 例（49.2%）患者的 LCIV 形态为 I 型，18 例（27.7%）为 II 型，15 例（23.1%）为 III 型。有 7 例（10.8%）患者发生 LCIV 损伤（I 型，n=0；II 型，n=2；III 型，n=5）（P=0.003）。LCIV 分类的观察者内可靠性为中等至极好，观察者间可靠性为中等至极好。
术前评估 L5-S1 节段前路手术时，应考虑 LCIV 的位置及其移动的难度。III 型 LCIV 形态显示出较高的血管损伤率。
