1Department of Orthopedic Surgery, Showa University, Tokyo.
2Department of Orthopedic Surgery, Showa University Koto Toyosu Hospital, Tokyo; and.
Neurosurg Focus. 2020 Sep;49(3):E11. doi: 10.3171/2020.6.FOCUS20361.
OBJECTIVE: The purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment. METHODS: A retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases. RESULTS: A total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001). CONCLUSIONS: LLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.
目的：本研究旨在通过倾向评分（PS）调整比较侧路腰椎间融合术（LLIF）与后路腰椎间融合术（PLIF）或经椎间孔腰椎间融合术（TLIF）在翻修椎间融合术中的临床结果，并基于影像学评估探讨 LLIF 对先前减压节段的间接减压效果。
方法：回顾性分析了接受后路减压术后复发神经症状的翻修手术患者。评估并比较了 LLIF 和 PLIF/TLIF 之间的术后并发症和手术因素。此外，还评估了 LLIF 病例中椎管和椎间孔横截面积（CSA）的术后改善情况。
结果：共纳入 56 例患者（LLIF 组 21 例，PLIF/TLIF 组 35 例）。单因素分析显示，LLIF 组终板损伤（p=0.03）和神经功能缺损（p=0.042）明显更多，而 PLIF/TLIF 组硬膜撕裂（p＜0.001）、手术部位感染（SSI）（p=0.02）和估计失血量（EBL）（p＜0.001）明显更多。PS 调整后，LLIF 组仍有明显更多的终板损伤（p=0.03），而 PLIF/TLIF 组硬膜撕裂（p＜0.001）、EBL（p＜0.001）和手术时间（p=0.04）明显更多。PLIF/TLIF 组 SSI 发生率较高（p=0.10）。两种手术方法的日本矫形协会评分改善无统计学差异（p=0.77）。椎管和椎间孔 CSA 均明显改善（p＜0.001）。
结论：对于先前减压节段的翻修手术，LLIF 是一种安全、有效、微创且并发症发生率可接受的方法。因此，LLIF 可以作为后路减压术后再狭窄的 PLIF/TLIF 的替代方法。
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