Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Sci Rep. 2019 Aug 19;9(1):12039. doi: 10.1038/s41598-019-48539-w.
This study examined the ability of the extreme lateral interbody fusion (XLIF) procedure to restore coronal and sagittal alignments for patients with adult spinal deformity (ASD) using computed tomography multiplanar reconstruction (CT-MPR). Thirty-eight patients with ASD undergoing correction and fixation with XLIF at 114 levels were studied. The coronal segmental Cobb angle, coronal regional Cobb angle (L1-5), sagittal segmental Cobb angle, sagittal regional Cobb angle (L1-5), intervertebral disc height and, vertebral body rotation (VBR) were measured before and after of XLIF surgery using CT-MPR. The mean sagittal segmental Cobb angle, the coronal segmental Cobb angle and VBR were corrected from 5.0° to 9.0°, from 6.3° to 4.3° and from 12.2° to 10.8°, respectively. The mean of the intervertebral disc heights increased significantly from 6.0 mm to 10.4 mm postoperatively. Although increases in coronal segmental Cobb, sagittal segmental Cobb, and intervertebral disc height at each level were significant, there were no significant differences in each parameter acquired by spine levels. The results also showed that it was difficult for L4/5 level to obtain the most postoperative coronal Cobb, sagittal Cobb and intervertebral disc height. This study evaluated the alignment improvement effect of stand-alone XLIF in ASD patients using CT-MPR. For the lower lumbar spine, it is difficult to obtain a lordosis more than 10 degrees with stand-alone XLIF for correcting ASD. Therefore, it is thought that correction such as osteotomy or compression technique to the posterior fusion may be necessary during the 2 stage surgery.
本研究通过计算机断层多平面重建（CT-MPR）检查了极外侧椎间融合术（XLIF）在成人脊柱畸形（ASD）患者中恢复冠状面和矢状面排列的能力。研究了 38 例在 114 个节段接受 XLIF 矫正和固定的 ASD 患者。使用 CT-MPR 术前和术后测量冠状节段 Cobb 角、冠状区域 Cobb 角（L1-5）、矢状节段 Cobb 角、矢状区域 Cobb 角（L1-5）、椎间盘高度和椎体旋转（VBR）。XLIF 手术后，平均矢状节段 Cobb 角、冠状节段 Cobb 角和 VBR 分别从 5.0°矫正至 9.0°、从 6.3°矫正至 4.3°和从 12.2°矫正至 10.8°。术后椎间盘高度平均显著增加 10.4mm。尽管每个节段的冠状节段 Cobb、矢状节段 Cobb 和椎间盘高度增加均有显著意义，但脊柱水平获得的每个参数均无显著差异。结果还表明，L4/5 水平很难获得术后冠状 Cobb、矢状 Cobb 和椎间盘高度最大。本研究通过 CT-MPR 评估了独立 XLIF 在 ASD 患者中的对线改善效果。对于下腰椎，独立 XLIF 很难获得超过 10 度的前凸来矫正 ASD。因此，认为在 2 期手术中可能需要进行后路融合的截骨或加压技术矫正。
