Department of Neurosurgery, University of Nebraska, Omaha, Nebraska.
Neurosurgical Associates of New Jersey, West Long Branch, New Jersey.
Neurosurgery. 2020 Feb 1;86(2):E147-E155. doi: 10.1093/neuros/nyz402.
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a well-accepted procedure for the treatment of degenerative lumbar disease. However, its ability to restore lumbar lordosis has been limited. Development of expandable lordotic interbody devices has challenged this limitation, furthering the scope of minimally invasive surgery.
To evaluate the radiographic and clinical effects of expandable lordotic interbody devices placed through an MIS-TLIF approach.
We conducted a retrospective review of 32 1-level and 18 2-level MIS-TLIFs performed using lordotic expandable interbody devices. Lumbar radiographic measurements, Oswestry Disability Index scores (ODI), and Visual Analogue Scale scores (VAS) were obtained at preoperative, 6 wk follow up, and last follow up time points. Last follow up occurred at a mean of 11.5 ± 7.6 mo (mean ± SD).
At 6-wk follow-up, segmental lordosis, disc height, and foraminal height increased by an average of 3.4°, 6.4 mm, and 4.4 mm, respectively. Only the 2-level group showed a significant increase in lumbar lordosis of 5.8°. No significant changes occurred in sacral slope, pelvic tilt, or pelvic incidence. Average ODI and VAS decreased by -12.0 and -4.5, respectively. Postoperative lumbar lordosis inversely correlated with preoperative lordosis in patients with an initial Pelvic Incidence to Lumbar Lordosis mismatch (PI-LL) of >10°, (r = -0.5, P = .009).
When applied across 2-levels, MIS-TLIF using expandable lordotic interbody devices produced a significant increase in lumbar lordosis. Preoperative lumbar lordosis was found to be a predictor of postoperative lumbar lordotic change in patients with sagittal imbalance.
微创经椎间孔腰椎体间融合术（MIS-TLIF）是治疗退行性腰椎疾病的一种被广泛接受的方法。然而，其恢复腰椎前凸的能力有限。可扩张的腰椎间融合器的发展挑战了这一限制，进一步扩大了微创手术的范围。
评估通过 MIS-TLIF 入路放置可扩张腰椎间融合器的影像学和临床效果。
我们对 32 例 1 节段和 18 例 2 节段的 MIS-TLIF 患者进行了回顾性研究，这些患者使用了可扩张的腰椎间融合器。在术前、6 周随访和最后随访时获得腰椎影像学测量、Oswestry 残疾指数（ODI）评分和视觉模拟量表（VAS）评分。最后一次随访的平均时间为 11.5±7.6 个月（均值±标准差）。
在 6 周随访时，节段性前凸角、椎间盘高度和椎间孔高度分别平均增加了 3.4°、6.4mm 和 4.4mm。只有 2 节段组的腰椎前凸增加了 5.8°，有统计学意义。骶骨倾斜角、骨盆倾斜角和骨盆入射角没有显著变化。平均 ODI 和 VAS 分别下降了-12.0 和-4.5。在初始骨盆入射角与腰椎前凸角不匹配（PI-LL）>10°的患者中，术后腰椎前凸角与术前腰椎前凸角呈负相关（r=-0.5，P=0.009）。
在 2 个节段应用时，使用可扩张腰椎间融合器的 MIS-TLIF 可显著增加腰椎前凸角。在矢状面失衡的患者中，术前腰椎前凸角是术后腰椎前凸角变化的预测因素。
