Xie Tianhang, Wang Chaoyang, Yang Zhiqiang, Xiu Peng, Yang Xi, Wang Xiandi, Wang Duan, Song Yueming, Zeng Jiancheng
Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China.
Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China.
World Neurosurg. 2020 Mar;135:e671-e678. doi: 10.1016/j.wneu.2019.12.105. Epub 2019 Dec 26.
The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes.
A total of 65 patients had undergone single-level OLIF-AF at L2-L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively.
The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P < 0.001). At 3 days postoperatively, the cross-sectional area had improved from 93.2 ± 14.4 mm to 124.2 ± 7.5 mm (P < 0.001), the disk height had increased from 9.9 ± 1.7 mm to 12.7 ± 1.0 mm (P < 0.001), the left FH had increased from 16.6 ± 2.0 mm to 19.6 ± 2.0 mm (P < 0.001). In contrast, the right FH had increased from 16.7 ± 2.1 mm to 19.9 ± 2.0 mm (P < 0.001), and the degree of upper vertebral slippage had decreased from 14.2% ± 3.1% to 4.6% ± 2.8% (P < 0.001), respectively. At the 12-month follow-up examination, these parameters showed no statistically significant differences compared with the values at 3 days postoperatively (P > 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%).
Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2-L5. Cage subsidence was the most common operative complication.
本研究旨在介绍一种采用斜外侧腰椎椎间融合术联合前外侧螺钉固定（OLIF-AF）进行间接减压治疗腰椎间盘退变疾病的方法，并检验其临床疗效和影像学结果。
2017年12月至2018年8月期间，共有65例患者在L2-L5节段接受了单节段OLIF-AF手术。使用磁共振成像评估硬脊膜囊的横截面积。使用计算机断层扫描评估椎间盘高度、椎间孔高度（FH）和上位椎体滑脱程度。记录术前和术后的视觉模拟评分和Oswestry功能障碍指数。
术后视觉模拟评分和Oswestry功能障碍指数均有显著改善（P < 0.001）。术后3天，横截面积从93.2±14.4平方毫米改善至124.2±7.5平方毫米（P < 0.001），椎间盘高度从9.9±1.7毫米增加至12.7±1.0毫米（P < 0.001），左侧FH从16.6±2.0毫米增加至19.6±2.0毫米（P < 0.001）。相比之下，右侧FH从16.7±2.1毫米增加至19.9±2.0毫米（P < 0.001），上位椎体滑脱程度从14.2%±3.1%降至4.6%±2.8%（P < 0.001）。在术后12个月的随访检查中，与术后3天的值相比，这些参数无统计学显著差异（P > 0.05）。15例患者（23.1%）出现不良事件，包括1例（1.5%）髂骨供区疼痛、2例（3.1%）左大腿疼痛/麻木、2例（3.1%）股四头肌无力、3例（4.6%）腰大肌无力、2例（3.1%）术中终板损伤和5例（7.7%）椎间融合器下沉。
我们的结果表明，OLIF-AF手术是治疗L2-L5节段腰椎间盘退变疾病的一种相对安全有效的手术选择。椎间融合器下沉是最常见的手术并发症。
