Amaral Rodrigo, Ferreira Ronaldo, Marchi Luis, Jensen Rubens, Nogueira-Neto Joes, Pimenta Luiz
Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.
University of California San Diego (UCSD), San Diego, United States.
Rev Bras Ortop. 2017 Sep 4;52(5):569-574. doi: 10.1016/j.rboe.2017.08.016. eCollection 2017 Sep-Oct.
Historically, anterior lumbar interbody fusion (ALIF) was related to high rates of intraoperative complications and adverse events related to interbody devices. In recent decades, there have been technical adjustments, and cages that are more suitable have emerged. The aim of this study is to evaluate the efficacy and complication rate of the use of stand-alone mini-ALIF using a self-locking cage.
Retrospective single center study. Inclusion criteria: retroperitoneal mini-ALIF for single-level fusion (L5S1); self-locking cage; DDD/stenosis and grade I spondylolisthesis. Exclusion criteria: posterior supplementation, previous fusion/arthroplasty. Endpoints: surgery data, intraoperative and perioperative adverse events related both to surgical access and to the intersomatic device.
Eighty-seven cases were enrolled. Median surgical time was 90 min; median blood loss was 100 mL. The median length of stay in the ICU was zero days; median hospital stay was one day. Ten cases had an adverse event (11.5%): four major adverse events (4.6%; 3 L bleeding; DVT; retroperitoneal haematoma; incisional hernia), and seven minor events (8%; peritoneum injury; minor vascular injury; events related to the cage). No cases of retrograde ejaculation were observed. There was improvement in pain, physical restriction, and quality of life ( < 0.001).
The mini-ALIF procedure performed for single-level fusion at the distal lumbar level demonstrated low adverse event rates related to both the surgical approach and to the intersomatic device, with reduced hospital stay and satisfactory perioperative clinical results.
从历史上看，腰椎前路椎间融合术（ALIF）与术中并发症及椎间融合器相关不良事件的高发生率有关。近几十年来，技术上有所调整，出现了更合适的椎间融合器。本研究的目的是评估使用自锁椎间融合器进行独立微创腰椎前路椎间融合术的疗效和并发症发生率。
回顾性单中心研究。纳入标准：用于单节段融合（L5S1）的腹膜后微创ALIF；自锁椎间融合器；椎间盘退变/狭窄和I度椎体滑脱。排除标准：后路补充手术、既往融合/置换手术。观察指标：手术数据、与手术入路及椎间融合器相关的术中及围手术期不良事件。
共纳入87例患者。中位手术时间为90分钟；中位失血量为100毫升。在重症监护病房的中位住院时间为0天；中位住院时间为1天。10例发生不良事件（11.5%）：4例严重不良事件（4.6%；3例大出血、深静脉血栓形成、腹膜后血肿、切口疝），7例轻微不良事件（8%；腹膜损伤、轻微血管损伤、与椎间融合器相关的事件）。未观察到逆行射精病例。疼痛、身体活动受限及生活质量均有改善（P<0.001）。
在腰椎下段进行单节段融合的微创ALIF手术，与手术入路及椎间融合器相关的不良事件发生率较低，住院时间缩短，围手术期临床结果令人满意。
