Scott-Young Matthew, McEntee Laurence, Furness James, Schram Ben, Hing Wayne, Grosser David, Zotti Mario
Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia.
Gold Coast Spine, Gold Coast, Queensland, Australia.
Int J Spine Surg. 2018 Aug 15;12(3):328-336. doi: 10.14444/5038. eCollection 2018 Jun.
Treatment options for aortic-iliac pathology may include endovascular repair and open surgical repair. Treatment options for degenerative disc disease (DDD) are varied but commonly include anterior reconstruction. When both the aortic-iliac and spinal pathologies are significant and surgical intervention is indicated for each pathology, the opportunity exists for concurrent treatment of both the aortic-iliac pathology and DDD in the same operation. The purpose of this case series was to document the safety and feasibility of a surgical strategy whereby a combined elective reconstructive procedure was performed for aortic and anterior lumbar spinal pathologies.
The case histories of 5 patients who were treated for both spinal and vascular pathology are presented. Surgical outcome measures included operative time, blood loss, length of stay, and complications. Spine-specific outcome measures included Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analogue scores (back and leg).
The spinal reconstructions performed included 1 L4-5 total disc replacement (TDR), 1 L4-5, L5-S1 anterior lumbar interbody fusion (ALIF), 1 L5-S1 ALIF, and 2 hybrid procedures (L4-5 TDR with L5-S1 ALIF). Vascular reconstructions included 4 aorto-bi-iliac bypass grafts and 1 aortic tube graft. The average operative time was 365 minutes (ranging between 330 and 510 minutes), the average blood loss was 1699 mL (range between 1160 and 2960 mL), and the average length of hospital stay was 14 days (range from 8 to 22 days). There were no in-hospital complications, and all patients experienced significant improvement in both back and leg pain. One patient developed kinking of the iliac limbs of the vascular graft 1 year postoperatively, which was managed with endovascular stenting of the graft.
Aortic-iliac pathology and DDD are significant pathologies often treated in isolation. This study illustrates that, despite its complexity, highly trained individuals in a specialized setting can perform combined surgery to achieve a satisfactory outcome for the patient.
Level IV evidence.
主动脉-髂动脉病变的治疗选择可能包括血管内修复和开放手术修复。退行性椎间盘疾病（DDD）的治疗选择多种多样，但通常包括前路重建。当主动脉-髂动脉和脊柱病变都很严重且每种病变都需要手术干预时，就有机会在同一手术中同时治疗主动脉-髂动脉病变和DDD。本病例系列的目的是记录一种手术策略的安全性和可行性，即对主动脉和腰椎前路病变进行联合择期重建手术。
介绍了5例同时接受脊柱和血管病变治疗的患者的病历。手术结果指标包括手术时间、失血量、住院时间和并发症。脊柱特异性结果指标包括Oswestry功能障碍指数、罗兰·莫里斯功能障碍问卷和视觉模拟评分（背部和腿部）。
进行的脊柱重建包括1例L4-5全椎间盘置换（TDR）、1例L4-5、L5-S1前路腰椎椎间融合术（ALIF）、1例L5-S1 ALIF和2例混合手术（L4-5 TDR联合L5-S1 ALIF）。血管重建包括4例主动脉-双髂动脉搭桥移植术和1例主动脉管状移植术。平均手术时间为365分钟（范围为330至510分钟），平均失血量为1699毫升（范围为1160至2960毫升），平均住院时间为14天（范围为8至22天）。住院期间无并发症，所有患者的背部和腿部疼痛均有明显改善。1例患者术后1年出现血管移植髂支扭结，通过血管内支架置入术进行处理。
主动脉-髂动脉病变和DDD是通常单独治疗的重要病变。本研究表明，尽管手术复杂，但在专业环境中训练有素的人员可以进行联合手术，为患者取得满意的结果。
四级证据。
