Katz Austen D, Singh Hardeep, Greenwood Matthew, Cote Mark, Moss Isaac L
Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT.
Clin Spine Surg. 2019 Oct;32(8):E386-E396. doi: 10.1097/BSD.0000000000000812.
Retrospective review of prospective data.
The objective of this study was to describe the clinical, radiographic, and complication-related outcomes through ≥1-year of 27 patients who underwent lateral lumbar interbody fusion (LLIF) with posterior instrumentation to treat ≥3 contiguous levels of degenerative lumbar scoliosis.
Multilevel disease has traditionally been treated with open posterior fusion. Literature on multilevel LLIF is limited. We present our experience with utilizing LLIF to treat multilevel degenerative scoliosis.
Clinical outcomes were evaluated using VAS, SF-12, and ODI. Radiographic outcomes included pelvic tilt, pelvic incidence, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, Cobb angle, and cage subsidence. Perioperative and long-term complications through the ≥1-year final-postoperative visit were reviewed; transient neurological disturbances were assessed independently. Demographic, comorbidity, operative, and recovery variables, including opioid use, were explored for association with primary outcomes.
Mean time to final-postoperative visit was 22.5 months; levels treated with LLIF per patient, 3.7; age, 66 years; and lateral operative time, 203 minutes. EBL was ≤100 mL in 74% of cases. Clinical outcomes remained significantly improved at ≥1-year. Cobb angle was corrected from 21.1 to 7.9 degrees (P<0.001), lordosis from 47.3 to 52.6 degrees (P<0.001), and mismatch from 11.4 to 6.4 degrees (P=0.003). High-grade subsidence occurred in 3 patients. Subsidence did not significantly impact primary outcomes. In total, 11.1% returned to the operating room for complication-related intervention over nearly 2-years; 37% experienced complications. Experiencing a complication was associated with having an open-posterior portion (P=0.048), but not with number of LLIF levels treated, or with clinical or radiographic outcomes. No patients experienced protracted neurological deficits; psoas weakness was associated with increased lateral operative time (P=0.049) and decreased surgeon experience (P=0.028).
Patients who underwent multilevel LLIF with adjunctive posterior surgery had significant clinical and radiographic improvements. Complication rates were similar compared to literature on single-level LLIF. LLIF is a viable treatment for multilevel degenerative scoliosis.
对前瞻性数据进行回顾性分析。
本研究的目的是描述27例行腰椎侧方椎间融合术（LLIF）并附加后路内固定术治疗≥3个连续节段退行性腰椎侧弯患者≥1年的临床、影像学及并发症相关结果。
传统上多节段疾病采用开放后路融合术治疗。关于多节段LLIF的文献有限。我们介绍了利用LLIF治疗多节段退行性脊柱侧弯的经验。
使用视觉模拟评分法（VAS）、简明健康调查量表（SF-12）和脊柱功能障碍指数（ODI）评估临床结果。影像学结果包括骨盆倾斜度、骨盆入射角、腰椎前凸、骨盆入射角与腰椎前凸不匹配度、Cobb角和椎间融合器下沉。回顾了≥1年术后最终随访时的围手术期和长期并发症；独立评估短暂性神经功能障碍。探讨人口统计学、合并症、手术及恢复变量，包括阿片类药物使用情况与主要结果的相关性。
术后最终随访的平均时间为22.5个月；每位患者接受LLIF治疗的节段数为3.7个；年龄为66岁；侧方手术时间为203分钟。74%的病例术中失血≤100毫升。≥1年时临床结果仍有显著改善。Cobb角从21.1度矫正至7.9度（P<0.001），前凸从47.3度增加至52.6度（P<0.001），不匹配度从11.4度降至6.4度（P=0.003）。3例患者发生高级别下沉。下沉对主要结果无显著影响。在近2年中，11.1%的患者因并发症相关干预返回手术室；37%的患者发生并发症。发生并发症与行开放后路部分手术有关（P=0.048），但与接受LLIF治疗的节段数、临床或影像学结果无关。无患者出现持续性神经功能缺损；腰大肌无力与侧方手术时间延长（P=0.049）和术者经验减少（P=0.028）有关。
接受多节段LLIF并附加后路手术的患者在临床和影像学方面有显著改善。与单节段LLIF的文献报道相比，并发症发生率相似。LLIF是治疗多节段退行性脊柱侧弯的一种可行方法。
