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单独侧方腰椎间融合术治疗 44 例相邻节段疾病的安全性和疗效。

The Safety and Efficacy of Stand-Alone Lateral Lumbar Interbody Fusion for Adjacent Segment Disease in a Cohort of 44 Patients.

机构信息

Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.

Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.

出版信息

World Neurosurg. 2021 May;149:e225-e230. doi: 10.1016/j.wneu.2021.02.046. Epub 2021 Feb 19.

Abstract

BACKGROUND

A mainstay of treatment for symptomatic adjacent segment disease (ASD) has consisted of revision with posterior decompression and fusion. This carries significant morbidity and can be technically difficult. An alternative is stand-alone lateral lumbar interbody fusion (LLIF), which may avoid complications associated with revision surgery. We describe the largest cohort of patients treated with LLIF for ASD to our knowledge.

METHODS

We conducted a retrospective cohort study on all patients who underwent transpsoas LLIF for ASD at a single academic center between 2012 and 2019. Postoperative improvement was measured using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).

RESULTS

Forty-four patients who underwent LLIF for ASD were identified. Median age was 65 years. Median time from index surgery to ASD development was 78 months. Median levels fused via LLIF was 1. Our median follow-up was 358 days. At follow-up, the median VAS back pain score was 0 (mean, 0.884), median VAS leg pain score was 1 (mean, 0.953), and median ODI was 8. The median improvement for VAS back pain was 8, for VAS leg pain was 6, and for ODI was 40. No patients suffered new neurologic symptoms postoperatively. Of the 17 patients who initially presented with non-pain neurologic symptoms, 8 (47.1%) experienced complete resolution of symptoms, and 5 (29.4%) experienced only some improvement.

CONCLUSIONS

To our knowledge, this is the largest cohort study of patients to date evaluating stand-alone LLIF for ASD. Our patient outcomes show it is safe and effective with low risk of morbidity.

摘要

背景

治疗有症状的邻近节段疾病(ASD)的主要方法一直是后路减压融合。这会带来很大的发病率,而且手术技术难度大。另一种方法是单纯的侧路腰椎椎间融合术(LLIF),它可以避免与翻修手术相关的并发症。我们描述了迄今为止我们所知的接受 LLIF 治疗 ASD 的最大患者队列。

方法

我们对 2012 年至 2019 年间在一家学术中心接受经椎间孔腰椎间融合术(LLIF)治疗 ASD 的所有患者进行了回顾性队列研究。术后改善通过视觉模拟量表(VAS)和 Oswestry 残疾指数(ODI)进行测量。

结果

共确定了 44 例接受 LLIF 治疗 ASD 的患者。中位年龄为 65 岁。从指数手术到 ASD 发展的中位时间为 78 个月。通过 LLIF 融合的中位数为 1 节。我们的中位随访时间为 358 天。在随访时,VAS 腰痛评分中位数为 0(平均 0.884),VAS 腿痛评分中位数为 1(平均 0.953),ODI 中位数为 8。VAS 腰痛的中位改善为 8,VAS 腿痛的中位改善为 6,ODI 的中位改善为 40。没有患者术后出现新的神经症状。在最初表现为非疼痛性神经症状的 17 名患者中,8 名(47.1%)症状完全缓解,5 名(29.4%)仅部分缓解。

结论

据我们所知,这是迄今为止评估 ASD 单纯性 LLIF 的最大患者队列研究。我们的患者结果表明,它是安全有效的,发病率低。

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