Kim Ki-Tack, Jo Dae-Jean, Lee Sang-Hyun, Seo Eun-Min
Department of Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Neurosurg Rev. 2018 Jan;41(1):355-363. doi: 10.1007/s10143-017-0927-8. Epub 2017 Oct 31.
In recent years, with advancements in surgical techniques and instrumentation, the lateral lumbar interbody fusion is being used increasingly as an alternative procedure to anterior approach. In this study, we illustrated a oblique retroperitoneal approach for lumbar interbody fusion with one incision site and tilting of the operation table in adult spinal deformity and evaluate the radiographical findings and clinical outcomes of patients treated using this technique. This study included 32 patients scheduled to undergo anterior and posterior long-level fusions for lumbar degenerative kyphosis or degenerative lumbar scoliosis. Data collected included blood loss, operative time, incision size, and perioperative complications. Pre- and postoperative radiographic parameters and clinical outcome measures were assessed. Mean follow-up time was 26.1 months. The mean blood losses were 107.4 and 102.4 ml, and the mean operative times were 116, 97, and 82 min for the patients within five levels (4 cases), four levels (18 cases), and three levels (10 cases). The mean incision sizes were 14.63, 13.82, and 12.5 cm in the patients with five, four, and three levels. The mean pelvic incidence was 50.3°. The mean preoperative sagittal vertical axis (SVA) was + 13.66 cm, and the last follow-up SVA was + 2.94 cm. The preoperative lumbar lordosis (LL) was 5.79°, and the last follow-up LL was 46.54°. The mean correction angle was 41°. The mean Cobb angle decreased from a preoperative value of 21.55° to 9.6°at the last follow-up. An oblique retroperitoneal approach is very safe, allowing reproducible access from L1 to S1 for lumbar interbody fusion in adult spinal deformity.
近年来，随着手术技术和器械的进步，腰椎外侧椎间融合术越来越多地被用作前路手术的替代方法。在本研究中，我们阐述了一种用于成人脊柱畸形腰椎椎间融合的斜行腹膜后入路，该入路只有一个切口部位且需手术台倾斜，并评估了采用该技术治疗患者的影像学结果和临床疗效。本研究纳入了32例计划接受前路和后路长节段融合术治疗腰椎退行性后凸或退行性腰椎侧凸的患者。收集的数据包括失血量、手术时间、切口大小和围手术期并发症。评估术前和术后的影像学参数及临床疗效指标。平均随访时间为26.1个月。五级（4例）、四级（18例）和三级（10例）患者的平均失血量分别为107.4 ml和102.4 ml，平均手术时间分别为116分钟、97分钟和82分钟。五级、四级和三级患者的平均切口大小分别为14.63 cm、13.82 cm和12.5 cm。平均骨盆入射角为50.3°。术前矢状面垂直轴（SVA）平均为+13.66 cm，末次随访时SVA为+2.94 cm。术前腰椎前凸（LL）为5.79°，末次随访时LL为46.54°。平均矫正角度为41°。平均Cobb角从术前的21.55°降至末次随访时的9.6°。斜行腹膜后入路非常安全，在成人脊柱畸形中可重复地从L1至S1进行腰椎椎间融合。
