Inoue Masahiro, Orita Sumihisa, Inage Kazuhide, Fujimoto Kazuki, Shiga Yasuhiro, Kanamoto Hirohito, Abe Koki, Kinoshita Hideyuki, Norimoto Masaki, Umimura Tomotaka, Sato Takashi, Sato Masashi, Suzuki Masahiro, Enomoto Keigo, Eguchi Yawara, Aoki Yasuchika, Akazawa Tsutomu, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopaedic surgery, Saiseikai Narashino Hospital, Narashino, Japan.
Spine Surg Relat Res. 2019 Oct 20;4(2):152-158. doi: 10.22603/ssrr.2019-0024. eCollection 2020.
There are several reports about invasive muscle injury during posterior spinal surgery. However, few reports have evaluated the association between the clinical symptoms and changes in the physical properties of the psoas major after oblique lateral interbody fusion (OLIF). Therefore, the current study aimed to investigate the relationship between the clinical symptoms and changes in the psoas major muscle before and after OLIF.
Twenty-seven patients who underwent single-level OLIF following the diagnosis of degenerative lumbar disease were included in the study. The cross-sectional areas (CSAs) of the psoas major on the approaching and contralateral sides were measured in the axial computed tomography view of the surgical intervertebral space preoperatively and postoperatively at 1 week and 3, 6, and 12 months. The preoperative and postoperative changes in the CSAs were compared. Muscle degeneration was evaluated using axial magnetic resonance images at the same level as that in the CSA evaluation preoperatively and at 12 months postoperatively. Additionally, the relationship between these parameters and postoperative lower limb symptoms was investigated.
Significant swelling of the psoas major on the approach side was observed 1 week postoperatively (p < 0.05). No postoperative muscle degeneration was observed. Three cases of paresthesia in the front of the thigh were observed, but no association was found with changes in CSA in any of the cases.
The OLIF approach caused swelling of the psoas major 1 week postoperatively with no more muscle degeneration in the mid-term. Although numbness of the lower limbs was found in some cases, no association was found with changes in CSA. Our study findings suggest that the OLIF approach causes temporary injury or swelling of the psoas major, but the long-term damage to the muscle is not significant.
关于后路脊柱手术期间的侵袭性肌肉损伤有多项报道。然而，很少有报道评估斜外侧椎间融合术（OLIF）后临床症状与腰大肌物理特性变化之间的关联。因此，本研究旨在探讨OLIF前后临床症状与腰大肌变化之间的关系。
本研究纳入了27例经诊断为退变性腰椎疾病后接受单节段OLIF的患者。在术前以及术后1周、3个月、6个月和12个月时，在手术椎间隙的轴向计算机断层扫描视图中测量手术侧和对侧腰大肌的横截面积（CSA）。比较CSA术前和术后的变化。在术前和术后12个月时，使用与CSA评估相同水平的轴向磁共振图像评估肌肉退变情况。此外，研究这些参数与术后下肢症状之间的关系。
术后1周观察到手术侧腰大肌明显肿胀（p < 0.05）。未观察到术后肌肉退变。观察到3例大腿前部感觉异常，但在任何病例中均未发现与CSA变化有关联。
OLIF手术入路导致术后1周腰大肌肿胀，中期无更多肌肉退变。虽然在某些病例中发现下肢麻木，但未发现与CSA变化有关联。我们的研究结果表明，OLIF手术入路会导致腰大肌暂时损伤或肿胀，但对肌肉的长期损害并不显著。
