Ebata Shigeto, Ohba Tetsuro, Haro Hirotaka
Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan.
Spine Surg Relat Res. 2018 Oct 30;3(1):106-111. doi: 10.22603/ssrr.2018-0079. eCollection 2019 Jan 25.
The lateral lumbar interbody fusion (LLIF) surgical approach is minimally invasive and safely accesses the target region. Therefore, it is widely used in cases of lumbar spinal stenosis and spinal deformity. Intraoperative neuromonitoring is necessary to avoid nerve injury, whereas postoperative anterior thigh symptoms are not necessarily prevented.
In our institute, 85 LLIF operations have been performed. The first 30 cases were excluded from the present study to avoid surgical learning curve effects; conventional monitoring was used in 30 cases, whereas a new method with a probe to monitor intramuscular potential was used in 25 other cases. Anterior thigh symptoms and motor deficits were assessed postoperatively. The location of the electromyographic threshold decrease was at the posterior part of the disc at L2-3, but at the anterior part at L4-5. Compared with conventional monitoring, the new intramuscular monitoring significantly decreased the prevalence of motor deficits of the iliopsoas at 1 day and 30 days; anterior thigh pain at 1 day, 30, and 90 days; and anterior thigh numbness at 30 and 90 days postoperatively.
Compared with conventional monitoring, the new intramuscular monitoring with a less invasive probe may reduce anterior thigh symptoms.
腰椎侧方椎间融合术（LLIF）手术入路具有微创性，能够安全地到达目标区域。因此，它被广泛应用于腰椎管狭窄症和脊柱畸形病例。术中神经监测对于避免神经损伤是必要的，而术后大腿前部症状不一定能得到预防。
在我们研究所，已经进行了85例LLIF手术。本研究排除了前30例以避免手术学习曲线效应；30例使用传统监测方法，另外25例使用一种带有监测肌内电位探头的新方法。术后评估大腿前部症状和运动功能障碍。肌电图阈值降低的位置在L2 - 3椎间盘后部，但在L4 - 5椎间盘前部。与传统监测相比，新的肌内监测在术后1天和30天时显著降低了髂腰肌运动功能障碍的发生率；在术后1天、30天和90天时降低了大腿前部疼痛的发生率；在术后30天和90天时降低了大腿前部麻木的发生率。
与传统监测相比，使用侵入性较小的探头进行新的肌内监测可能会减少大腿前部症状。
