Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1411-E1418. doi: 10.1097/BRS.0000000000003180.
MINI: On magnetic resonance imaging, indirect decompression using lateral lumbar interbody fusion and posterior fixation was confirmed immediately after surgery and also continuously progressed after surgery, particularly during the first 6 months. Thecal sac enlargement was also confirmed, and is suspected to be caused by the atrophy of the ligamentum flavum and the disc.
A prospective cohort study.
The aim of this study was to investigate radiographical changes related to indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation.
Indirect lumbar decompression via LLIF is used to treat degenerative lumbar diseases requiring neural decompression. Although evidence suggests that thecal sac enlargement follows shortly after surgery, few studies have described the postoperative changes on MRIs.
This study involved 102 patients who underwent indirect decompression at 136 levels, with LLIF and posterior fixation. Magnetic resonance imaging (MRIs) were collected preoperatively and several times postoperatively (over a 2-year period starting immediately after surgery). We then quantified the cross-sectional areas of the thecal sac and ligamentum flavum, as well as the anteroposterior diameter of disc bulging, and qualitatively assessed lumbar spinal stenosis according to a modified version of Schizas' classification [Grades A (mild) to C (severe)]. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for the assessment of the clinical symptoms.
All changes were observable immediately after surgery, progressed over time, and were significantly different statistically at 2 years after surgery. The thecal sac was significantly larger (189% of preoperative; P < 0.0001), while the ligamentum flavum and disc bulge were significantly smaller [58.9% and 67.3% of preoperative (P < 0.001), respectively]. The number of patients with grade C (severe) lumbar stenosis also dropped significantly (preoperative, 17.6%; 2 years postoperative, 0%). There were no significant differences in JOABPEQ results at 6 months, 1 year, and 2 years postsurgery.
Indirect decompression produces immediate positive results that continue to improve over time. The cross-sectional area of the thecal sac doubled by 2 years after surgery, and the ligamentum flavum cross-sectional area and disc bulging both shrank significantly. At the same time, however, postoperative radiographical improvements do not appear to correlate with clinical symptoms.
MINI：在磁共振成像上，使用侧方腰椎椎间融合和后路固定进行间接减压，术后即刻得到确认，并在术后持续进展，尤其是在术后 6 个月内。还确认了硬脊膜囊扩大，怀疑是黄韧带和椎间盘萎缩所致。
前瞻性队列研究。
本研究旨在探讨使用后路固定的侧方腰椎椎间融合术（LLIF）进行间接减压的影像学变化。
通过 LLIF 进行间接腰椎减压，用于治疗需要神经减压的退行性腰椎疾病。尽管有证据表明，硬脊膜囊扩大紧随手术之后，但很少有研究描述术后 MRI 的变化。
本研究纳入了 102 例在 136 个节段接受间接减压的患者，采用 LLIF 和后路固定。在术前和术后多次（从术后即刻开始，持续 2 年）采集磁共振成像（MRI）。我们随后量化了硬脊膜囊和黄韧带的横截面积，以及椎间盘膨出的前后径，并根据 Schizas 改良分级[Grade A（轻度）至 C（重度）]对腰椎椎管狭窄进行定性评估。日本骨科协会腰痛评估问卷（JOABPEQ）用于评估临床症状。
所有变化在术后即刻即可观察到，并随时间推移而进展，术后 2 年时具有统计学显著差异。硬脊膜囊明显增大（术前的 189%；P<0.0001），而黄韧带和椎间盘膨出明显减小[术前的 58.9%和 67.3%（P<0.001）]。C 级（重度）腰椎管狭窄的患者数量也显著减少（术前 17.6%；术后 2 年 0%）。术后 6 个月、1 年和 2 年时，JOABPEQ 结果无显著差异。
间接减压即刻产生积极效果，且随时间推移持续改善。术后 2 年时，硬脊膜囊横截面积增加了一倍，黄韧带横截面积和椎间盘膨出均显著缩小。然而，同时，术后影像学改善似乎与临床症状无关。
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