Orita Sumihisa, Nakajima Takao, Konno Kenta, Inage Kazuhide, Sainoh Takeshi, Fujimoto Kazuki, Sato Jun, Shiga Yasuhiro, Kanamoto Hirohito, Abe Koki, Inoue Masahiro, Kinoshita Hideyuki, Norimoto Masaki, Umimura Tomotaka, Aoki Yasuchika, Nakamura Junichi, Matsuura Yusuke, Kubota Go, Eguchi Yawara, Hynes Richard A, Akazawa Tsutomu, Suzuki Miyako, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopedic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Spine Surg Relat Res. 2018 Jan 27;2(1):86-92. doi: 10.22603/ssrr.2017-0035. eCollection 2018.
Failed spinal fusion surgery sometimes requires salvage surgery when symptomatic, especially with postsurgical decrease in intervertebral disc height followed by foraminal stenosis. For such cases, an anterior approach to lumbar lateral interbody fusion (LLIF) provides safe, direct access to the pathological disc space and a potential improvement in the fusion rate. One LLIF approach, oblique lateral interbody fusion (OLIF), targets the oblique lateral window of the intervertebral discs to achieve successful lateral interbody fusion. The current technical note describes spinal revision surgery using the OLIF procedure.
The subjects were patients with leg pain and/or lower back pain derived from decreased intervertebral height followed by foraminal stenosis due to failed spinal fusion surgery. These patients underwent additional OLIF surgery and posterior fusion with no additional posterior direct decompression. Their outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scores at baseline and final follow-up. Bony union was also evaluated using computed tomography images at final follow-up. Six subjects were evaluated, with two representative cases described in detail. Four patients had an adjacent segment disorder, and the other two patients had pseudarthrosis due to postoperative infection. The mean JOA score improved from 5.7 ± 5.4 to 21.2 ± 2.3, with a mean recovery rate of 65.0%. All cases showed intervertebral bony union.
We introduced a salvage strategy for failed posterior spine fusion surgery cases using the OLIF procedure. Patients effectively achieved recovered intervertebral and foraminal height with no additional posterior direct decompression.
脊柱融合手术失败有时在出现症状时需要进行挽救性手术，尤其是术后椎间盘高度降低并继发椎间孔狭窄的情况。对于此类病例，腰椎外侧椎间融合术（LLIF）的前路入路可安全、直接地进入病变椎间盘间隙，并可能提高融合率。一种LLIF入路，即斜外侧椎间融合术（OLIF），通过靶向椎间盘的斜外侧窗口来实现成功的外侧椎间融合。本技术说明介绍了使用OLIF手术进行的脊柱翻修手术。
研究对象为因脊柱融合手术失败导致椎间盘高度降低并继发椎间孔狭窄而出现腿痛和/或腰痛的患者。这些患者接受了额外的OLIF手术和后路融合术，未进行额外的后路直接减压。在基线和最终随访时使用日本骨科协会（JOA）评分评估其结果。在最终随访时还使用计算机断层扫描图像评估骨融合情况。共评估了6名受试者，详细描述了2例代表性病例。4例患者存在相邻节段疾病，另外2例患者因术后感染出现假关节。JOA评分平均从5.7±5.4提高到21.2±2.3，平均恢复率为65.0%。所有病例均显示椎间骨融合。
我们介绍了一种使用OLIF手术对后路脊柱融合手术失败病例的挽救策略。患者在未进行额外后路直接减压的情况下有效地恢复了椎间和椎间孔高度。
