Ziino Chason, Arzeno Alexander, Cheng Ivan
Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
J Spine Surg. 2019 Jun;5(2):201-206. doi: 10.21037/jss.2019.05.09.
To analyze perioperative and radiographic outcomes following revision surgery using lateral lumbar interbody fusion (LLIF) performed entirely in the lateral position. Traditionally, patients undergoing interbody fusion in the lateral decubitus position are placed prone for pedicle screw fixation. However prone positioning carries known risks and may increase surgical time due to the need to re-drape and reposition. Little is published regarding revision surgery in a single position.
Sixteen patients over the age of 18 with degenerative lumbar pathology who underwent a revision of previous lumbar fusion using interbody fusion via lateral access and revision of posterior instrumentation from a single surgeon met inclusion criteria. Patients who underwent combined procedures requiring repositioning or had inadequate preoperative imaging were excluded. Patients remained in the lateral decubitus position for the entirety of the procedure including interbody placement, revision of prior instrumentation, and pedicle screw fixation. Demographics, surgical details, and perioperative outcomes were reported.
The mean operative time was 211 minutes for all cases, 161 minutes for single-level procedures and 296 minutes for two-level procedures. Mean estimated blood loss was 206 cc. The mean patient age was 66, 70% of which were male. The mean body mass index (BMI) was 27.4 and Charleson Comorbidity Index (CCI) was 3. All cases were performed on the lumbar spine (T12/L1-L4/L5), with the majority of procedures performed at the L2/3 level (44%). The mean pelvic incidence (PI) was 60 degrees (range, 41-71 degrees) with mean preoperative PI/lumbar lordosis (LL) mismatch of 23.9 degrees. Mean postoperative PI/LL mismatch was 12 degrees.
Revision surgery in the lateral position is feasible with complication rates comparable to published literature. The need to reposition is eliminated and single position surgery reduces operative time.
分析完全采用侧卧位行腰椎外侧椎间融合术（LLIF）翻修手术后的围手术期及影像学结果。传统上，行侧卧位椎间融合术的患者需俯卧位进行椎弓根螺钉固定。然而，俯卧位存在已知风险，且由于需要重新铺巾和重新摆放体位，可能会增加手术时间。关于单一体位下的翻修手术，相关报道较少。
16例年龄超过18岁、患有退行性腰椎疾病且接受过腰椎融合翻修术的患者符合纳入标准，该翻修术采用外侧入路椎间融合及同一位外科医生进行后路内固定翻修。排除接受需要重新摆放体位的联合手术或术前影像学资料不充分的患者。患者在整个手术过程中均保持侧卧位，包括椎间融合器置入、先前内固定翻修及椎弓根螺钉固定。报告患者的人口统计学资料、手术细节及围手术期结果。
所有病例的平均手术时间为211分钟，单节段手术为161分钟，双节段手术为296分钟。平均估计失血量为206毫升。患者平均年龄为66岁，其中70%为男性。平均体重指数（BMI）为27.4，Charlson合并症指数（CCI）为3。所有手术均在腰椎（T12/L1 - L4/L5）进行，大多数手术在L2/3节段（44%）进行。平均骨盆入射角（PI）为60度（范围41 - 71度），术前平均PI/腰椎前凸（LL）不匹配度为23.9度。术后平均PI/LL不匹配度为12度。
侧卧位翻修手术是可行的，并发症发生率与已发表文献相当。消除了重新摆放体位的需求，单一体位手术减少了手术时间。
