Huang Chunneng, Xu Zhengkuan, Li Fangcai, Chen Qixin
Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
J Korean Neurosurg Soc. 2018 Nov;61(6):707-715. doi: 10.3340/jkns.2017.0296. Epub 2018 Jun 26.
To investigate the potential risk of approach-related complications at different access angles in minimally invasive lateral lumbar interbody fusion.
Eighty-six axial magnetic resonance images were obtained to analyze the risk of approach-related complications. The access corridor were simulated at different access angles and the potential risk of neurovascular structure injury was evaluated when the access corridor touching or overlapping the corresponding structures at each angle. Furthermore, the safe corridor length was measured when the corridor width was 18 and 22 mm.
When access angle was 0°, the potential risk of ipsilateral nerve roots injury was 54.7% at L4-L5. When access angle was 45°, the potential risk of abdominal aorta, contralateral nerve roots or central canal injury at L4-L5 was 79.1%, 74.4%, and 30.2%, respectively. The length of the 18mm-wide access corridor was largest at 0° and it could reach 44.5 mm at L3-L4 and 46.4 mm at L4-L5. While the length of the 22 mm-wide access corridor was 42.3 mm at L3-L4 and 44.1 mm at L4-L5 at 0°.
Changes in the access angle would not only affect the ipsilateral neurovascular structures, but also might adversely influence the contralateral neural elements. It should be also noted to surgeons that alteration of the access angle changed the corridor length.
探讨微创外侧腰椎椎间融合术中不同入路角度相关并发症的潜在风险。
获取86例轴向磁共振图像以分析入路相关并发症的风险。在不同入路角度模拟入路通道，并评估每个角度入路通道接触或重叠相应结构时神经血管结构损伤的潜在风险。此外，在通道宽度为18毫米和22毫米时测量安全通道长度。
当入路角度为0°时，L4-L5节段同侧神经根损伤的潜在风险为54.7%。当入路角度为45°时，L4-L5节段腹主动脉、对侧神经根或中央管损伤的潜在风险分别为79.1%、74.4%和30.2%。18毫米宽的入路通道长度在0°时最大，在L3-L4节段可达44.5毫米，在L4-L5节段可达46.4毫米。而22毫米宽的入路通道长度在0°时，L3-L4节段为42.3毫米，L4-L5节段为44.1毫米。
入路角度的改变不仅会影响同侧神经血管结构，还可能对侧方神经结构产生不利影响。外科医生还应注意，入路角度的改变会改变通道长度。
