Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC.
Atlantic Neurosurgical and Spine Specialists, Wilmington, NC.
Spine (Phila Pa 1976). 2018 Mar 15;43(6):440-446. doi: 10.1097/BRS.0000000000002330.
Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon.
To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation.
Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis.
The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded.
Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms.
The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with intraoperative repositioning and may lead to significant improvements in operative efficiency and cost savings.
对由一位脊柱外科医生采用单一切口、单侧或双侧经皮椎弓根螺钉和棒固定的经单一位置行单侧（LLIF）或斜外侧椎间融合（OLLIF）治疗的最初 72 例连续患者前瞻性收集数据的回顾性研究。
评估单一切口技术用于经单一位置行双侧经皮椎弓根螺钉和棒固定的 LLIF 和 OLLIF 的临床可行性、准确性和效率。
微创侧方入路在侧卧位下进行。随后为双侧椎弓根螺钉和棒固定重新置于俯卧位需要大量的时间和资源，并且不利于腰椎前凸增加。
纳入了 2013 年 12 月至 2016 年 8 月期间由同一位医生采用单一切口 LLIF 或 OLLIF 以及双侧椎弓根螺钉治疗的前 72 例连续患者（300 枚螺钉）。使用计算机断层扫描（CT）对螺钉的准确性和融合情况进行分级，并记录了几个时间参数，包括牵开器、透视和螺钉放置时间。记录了包括再手术、感染以及术后神经根痛和无力在内的并发症。
平均螺钉放置时间为 5.9 分钟/螺钉（标准差[SD]：1.5 分钟；范围：3-9.5 分钟）。平均总手术时间（椎间融合器和椎弓根螺钉置入）为 87.9 分钟（SD：25.1 分钟；范围：49-195 分钟）。平均透视时间为 15.0 秒/螺钉（SD：4.7 秒；范围：6-25 秒）。螺钉穿透率为 5.1%，其中 10/13 处穿透的程度<2mm。术后 6 个月融合率为 87.5%。2 例（2.8%）患者因椎弓根螺钉位置不当而行再手术，随后症状缓解。
单一切口、全外侧技术具有可行性，准确性、透视使用和并发症发生率与已发表的文献相当。该技术消除了术中重新定位所需的时间和人员配备，可能会显著提高手术效率并节省成本。
4 级
