J Neurosurg Spine. 2019 Apr 5;31(1):46-52. doi: 10.3171/2019.1.SPINE18754. Print 2019 Jul 1.
Sagittal imbalance and loss of lumbar lordosis are the main drivers of functional disability in adult degenerative scoliosis. The main limitations of the classic posterior lumbar interbody fusion technique are increased risk of neurological injury and suboptimal correction of the segmental lordosis. Here, the authors describe the radiological results of a modified posterior lumbar interbody fusion and compare the results with a historical cohort of patients.
Eighty-two consecutive patients underwent surgical treatment for degenerative scoliosis/kyphosis in a single tertiary referral center for complex spinal surgery. Fifty-five patients were treated using the classic multilevel posterior lumbar interbody fusion (MPLIF) technique and 27 were treated using the modified MPLIF technique to include a release of the anterior longitudinal ligament (ALL) and the annulus. A radiographic review of both series of patients was performed by two independent observers. Functional outcomes were obtained, and patients were registered in the European Spine Tango registry.
The mean L4-5 disc angle increased by 3.14° in the classic MPLIF group and by 12.83° in MPLIF plus ALL and annulus release group. The mean lumbar lordosis increased by 15.23° in the first group and by 25.17° in the second group. The L4-S1 lordosis increased on average by 4.92° in the classic MPLIF group and increased by a mean of 23.7° in the MPLIF plus ALL release group when both L4-5 and L5-S1 segments were addressed. There were significant improvements in the Core Outcome Measures Index and EQ-5D score in both groups (p < 0.001). There were no vascular or neurological injuries observed in either group.
The authors' preliminary results suggest that more correction can be achieved at the disc level using posterior-based ALL and annulus release in conjunction with posterior lumbar interbody fusion. They demonstrate that ALL and annulus release can be performed safely using a posterior-only approach with minimal risk of vascular injury. However, the authors recommend that this approach should only be used by surgeons with considerable experience in anterior and posterior spinal surgery.
矢状面失衡和腰椎前凸丢失是成人退行性脊柱侧凸导致功能障碍的主要原因。经典后路腰椎椎间融合技术的主要局限性在于增加了神经损伤的风险，并且对节段前凸的矫正效果不佳。在此，作者描述了改良后路腰椎椎间融合术的影像学结果，并与历史队列的患者进行了比较。
在一家专注于复杂脊柱手术的三级转诊中心，82 例连续退行性脊柱侧凸/后凸患者接受了手术治疗。55 例患者采用经典的多节段后路腰椎椎间融合术（MPLIF）治疗，27 例采用改良的 MPLIF 技术治疗，包括前纵韧带（ALL）和纤维环松解。由两位独立观察者对两组患者进行影像学检查。获取功能结果，并将患者登记在欧洲脊柱探戈登记处。
经典 MPLIF 组 L4-5 椎间盘角度平均增加 3.14°，MPLIF 加 ALL 和纤维环松解组平均增加 12.83°。第一组的平均腰椎前凸增加 15.23°，第二组增加 25.17°。经典 MPLIF 组 L4-S1 前凸平均增加 4.92°，当处理 L4-5 和 L5-S1 节段时，MPLIF 加 ALL 松解组平均增加 23.7°。两组的核心结局测量指标和 EQ-5D 评分均有显著改善（p<0.001）。两组均未观察到血管或神经损伤。
作者的初步结果表明，在后路基础上结合后路腰椎椎间融合术进行 ALL 和纤维环松解可以在椎间盘水平获得更多的矫正。他们证明，使用仅后路入路可以安全地进行 ALL 和纤维环松解，血管损伤的风险极小。然而，作者建议只有在具有丰富的前路和后路脊柱手术经验的外科医生中才应使用这种方法。
