Timothy J, Pal D, Akhunbay-Fudge C, Knights M, Frost A, Derham C, Selvanathan S
Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
J Clin Neurosci. 2019 Jan;59:213-217. doi: 10.1016/j.jocn.2018.10.063. Epub 2018 Nov 6.
Extreme lateral interbody fusion (XLIF) is a minimally invasive lateral trans-psoas approach to the thoraco-lumbar spine that enables surgical debridement of the disc space and facilitates fusion. Previous reports are limited to case series, which have no outcomes measuring improvement. We aim to determine the effectiveness of XLIF in the treatment of patients with spondylodiscitis. We performed a cohort study over four years (2008-2011). Patients were treated with XLIF if they met our selection criteria - symptoms suggestive of discitis with consistent imaging and intractable back pain making patients bedbound. Patients were excluded if medically unfit for surgery. Pre and post-operative VAS and ODI scores were used as formal outcome measures. 14 patients were included and at 12 months, median VAS and ODI scores had improved 4.0 (95% CI, 1.9-6.5) (p = 0.005) and 37.0% (95% CI, 10.7-53.7) (p = 0.015) respectively. All patients with available imaging showed evidence of fusion. Patients typically received 6-8 weeks of antibiotics and all showed normalisation of inflammatory markers. At 5 year follow-up, median VAS and ODI were still improved at 3.0 (95% CI, 1.7-4.4) (p = 0.01) and 40% (95% CI, 10-52) (p = 0.028) respectively. The median length of inpatient stay was 10 days (range 4-40 days). This is the first study to demonstrate that the XLIF technique can significantly improve pain in discitis patients using validated formal outcome measurements. This technique could therefore potentially be used to reduce pain in patients with discitis, help them to mobilise earlier and reduce the duration of their hospital stay.
极外侧椎间融合术（XLIF）是一种用于胸腰椎的微创经腰大肌外侧入路手术，可实现椎间盘间隙的手术清创并促进融合。以往的报告仅限于病例系列，没有测量改善情况的结果。我们旨在确定XLIF治疗脊椎椎间盘炎患者的有效性。我们进行了一项为期四年（2008 - 2011年）的队列研究。如果患者符合我们的选择标准——有提示椎间盘炎的症状且影像学表现一致，同时存在顽固性背痛导致患者卧床不起，则采用XLIF进行治疗。如果患者身体状况不适合手术则被排除。术前和术后的视觉模拟评分（VAS）和功能障碍指数（ODI）评分被用作正式的结果指标。纳入了14名患者，在12个月时，VAS评分中位数改善了4.0（95%置信区间，1.9 - 6.5）（p = 0.005），ODI评分改善了37.0%（95%置信区间，10.7 - 53.7）（p = 0.015）。所有有可用影像学资料的患者均显示有融合迹象。患者通常接受6 - 8周的抗生素治疗，所有患者的炎症指标均恢复正常。在5年随访时，VAS评分中位数仍改善了3.0（95%置信区间，1.7 - 4.4）（p = 0.01），ODI评分改善了40%（95%置信区间，10 - 52）（p = 0.028）。住院时间中位数为10天（范围4 - 40天）。这是第一项使用经过验证的正式结果测量方法证明XLIF技术可显著改善椎间盘炎患者疼痛的研究。因此，该技术有可能用于减轻椎间盘炎患者的疼痛，帮助他们更早活动并缩短住院时间。
