Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China.
Orthop Surg. 2021 Apr;13(2):466-473. doi: 10.1111/os.12890. Epub 2021 Jan 28.
The aim of the present paper was to evaluate cases of lumbar degenerative diseases treated with oblique lateral interbody fusion (OLIF) using a modified lateral approach (i.e. anteroinferior psoas exposure under direct vision) and to analyze the effect and safety of this approach.
From June 2016 to April 2019, a total of 226 patients with an average age of 65.5 ± 16.2 years (98 men and 128 women) with degenerative lumbar diseases who underwent the AIP approach of OLIF were followed up and analyzed retrospectively. Data concerning operative and clinical parameters were collected, including operative time, intraoperative estimated blood loss, duration of postoperative hospital stay, and time to ambulation after surgery. For the assessment of clinical outcomes, the visual analogue scale (VAS) score (for back pain) and the Oswestry disability index (ODI) were calculated. Complications were also recorded as surgical exposure approach-related complications. More than 6 months after surgery, 132 patients consented to having MRI examinations to evaluate the psoas muscle atrophy when they were followed up.
The mean operative time was 82.5 ± 31.6 min. The mean operative time for each segment of OLIF was 43.3 ± 15.5 min. The mean blood loss was 48.0 ± 11.6 mL. The mean blood loss for each segment of OLIF was 25.3 ± 10.1 mL. No patients needed blood transfusion intraoperatively or postoperatively. The mean hospital stay was 4.1 ± 2.1 days. All patients were followed up for 12-31 months (mean 18.2 months). Clinical assessment showed that the VAS and ODI scores at 6 months after surgery were markedly lower than the preoperative scores (P < 0.001) but did not differ from the scores at the final follow-up (P > 0.05). There was no significant difference in percentage changes of the cross-sectional area of the lean psoas muscle and the T2 signal intensity ratio of gross psoas to quadratus lumborum muscles between the left side (operative side) and the right side (nonoperative side) (P > 0.05). A total of 11 surgical exposure approach-related complications were reported, with an incidence of 4.9%: transient thigh pain/numbness, psoas weakness (2.2%), sympathetic chain injury (1.3%), cage subsidence (0.9%), and segmental artery injury (0.4%). There was no permanent motor neurological deficit, and no injury of vascular, ureter or peritoneal membranes.
The anteroinferior psoas approach for OLIF is safe and can preserve the psoas and lumbar plexus.
本研究旨在评估采用改良侧前方入路（即直接可视下前路经腰大肌入路）治疗腰椎退行性疾病的病例，并分析该入路的效果和安全性。
回顾性分析 2016 年 6 月至 2019 年 4 月采用改良侧前方入路行斜外侧椎间融合术（OLIF）治疗的 226 例平均年龄 65.5±16.2 岁（男 98 例，女 128 例）腰椎退行性疾病患者的临床资料。收集手术和临床参数，包括手术时间、术中估计失血量、术后住院时间和术后下床时间。采用视觉模拟评分（VAS）（腰痛）和 Oswestry 功能障碍指数（ODI）评估临床疗效。记录并发症，包括手术暴露相关并发症。术后 6 个月以上，132 例患者在随访时同意进行 MRI 检查以评估腰大肌萎缩情况。
手术时间平均为 82.5±31.6min。OLIF 每节段的手术时间平均为 43.3±15.5min。术中出血量平均为 48.0±11.6mL。OLIF 每节段的术中出血量平均为 25.3±10.1mL。术中及术后均无需输血。平均住院时间为 4.1±2.1 天。所有患者均获得 12-31 个月（平均 18.2 个月）随访。临床评估显示，术后 6 个月时 VAS 和 ODI 评分明显低于术前（P<0.001），但与末次随访时无差异（P>0.05）。左侧（手术侧）和右侧（非手术侧）腰大肌横截面积百分比变化和腰大肌与竖脊肌 T2 信号强度比无显著差异（P>0.05）。共报告 11 例手术暴露相关并发症，发生率为 4.9%：短暂大腿疼痛/麻木、腰大肌无力（2.2%）、交感神经链损伤（1.3%）、融合器下沉（0.9%）和节段性动脉损伤（0.4%）。无永久性运动神经功能缺损，也无血管、输尿管或腹膜损伤。
OLIF 前路经腰大肌入路安全，可保留腰大肌和腰丛。
