与前路腰椎椎间融合术相比，后路经腰大肌腰椎椎间融合术治疗退行性腰椎滑脱症的估计失血量减少。
Decreased estimated blood loss in lateral trans-psoas versus anterior approach to lumbar interbody fusion for degenerative spondylolisthesis.
作者信息
Goodnough L Henry, Koltsov Jayme, Wang Tianyi, Xiong Grace, Nathan Karthik, Cheng Ivan
机构信息
Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
出版信息
J Spine Surg. 2019 Jun;5(2):185-193. doi: 10.21037/jss.2019.05.08.
BACKGROUND
The goal of the current study was to compare the perioperative and post-operative outcomes of eXtreme lateral trans-psoas approach (XLIF) versus anterior lumbar interbody fusion (ALIF) for single level degenerative spondylolisthesis. The ideal approach for degenerative spondylolisthesis remains controversial.
METHODS
Consecutive patients undergoing single level XLIF (n=21) or ALIF (n=54) for L4-5 degenerative spondylolisthesis between 2008-2012 from a single academic center were retrospectively reviewed. Groups were compared for peri-operative data (estimated blood loss, operative time, adjunct procedures or additional implants), radiographic measurements (L1-S1 cobb angle, disc height, fusion grade, subsidence), 30-day complications (infection, DVT/PE, weakness/paresthesia, etc.), and patient reported outcomes (leg and back Numerical Rating Scale, and Oswestry Disability Index).
RESULTS
Estimated blood loss was significantly lower for XLIF [median 100; interquartile range (IQR), 50-100 mL] than for ALIF (median 250; IQR, 150-400 mL; P<0.001), including after adjusting for significantly higher rates of posterior decompression in the ALIF group. There were no significant differences in rates of complications within 30 days, radiographic outcomes, or in re-operation rates. Both groups experienced significant pain relief post-operatively.
CONCLUSIONS
The lateral trans-psoas approach is associated with diminished blood loss compared to the anterior approach in the treatment of degenerative spondylolisthesis. We were unable to detect differences in radiographic outcomes, complication rates, or patient reported outcomes. Continued efforts to directly compare approaches for specific indications will minimize complications and improve outcomes. Further studies will continue to define indications for lateral versus anterior approach to lumbar spine for degenerative spondylolisthesis.
背景
本研究的目的是比较极外侧经腰大肌入路（XLIF）与前路腰椎椎间融合术（ALIF）治疗单节段退变性腰椎滑脱症的围手术期及术后结果。对于退变性腰椎滑脱症的理想手术入路仍存在争议。
方法
回顾性分析2008年至2012年期间，在单一学术中心接受L4-5退变性腰椎滑脱症单节段XLIF手术（n=21）或ALIF手术（n=54）的连续患者。比较两组的围手术期数据（估计失血量、手术时间、辅助手术或额外植入物）、影像学测量指标（L1-S1 Cobb角、椎间盘高度、融合等级、沉降）、30天并发症（感染、深静脉血栓形成/肺栓塞、无力/感觉异常等）以及患者报告的结果（腿部和背部数字评分量表以及Oswestry功能障碍指数）。
结果
XLIF组的估计失血量[中位数100；四分位数间距（IQR），50-100 mL]显著低于ALIF组（中位数250；IQR，150-400 mL；P<0.001），即使在对ALIF组中显著更高的后路减压率进行校正后亦是如此。两组在30天内的并发症发生率、影像学结果或再次手术率方面均无显著差异。两组术后均有明显的疼痛缓解。
结论
在治疗退变性腰椎滑脱症方面，与前路手术相比，经腰大肌外侧入路的失血量减少。我们未能发现影像学结果、并发症发生率或患者报告结果方面的差异。持续努力直接比较针对特定适应症的手术入路将使并发症最小化并改善结果。进一步的研究将继续明确腰椎退变性腰椎滑脱症采用外侧入路与前路入路的适应症。
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