Department of Orthopedic Surgery, Hospital for Special Surgery.
Department of Vascular Surgery, New York Presbyterian Hospital, New York, NY.
Clin Spine Surg. 2021 Mar 1;34(2):E92-E99. doi: 10.1097/BSD.0000000000001044.
Description of surgical technique and retrospective review.
To describe a novel surgical technique for multilevel lumbar fusion and describe early clinical results.
Patients with multilevel lumbar spinal stenosis and adult degenerative scoliosis often require multilevel interbody placement to achieve indirect decompression and lordosis. We describe a case series of patients treated with simultaneous lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) at L5-S1.
We retrospectively reviewed a consecutive series of patients treated for multilevel lumbar spinal stenosis with simultaneous ALIF and LLIF with at least 3-month follow-up. All patients received supplemental percutaneous bilateral pedicle screw placement as well. We measured on preoperative radiographs their lumbar lordosis, pelvic incidence, and L5-S1 lordosis. Intraoperative factors such as operative time, estimated blood loss, fluids provided, number of levels fused, and whether a trainee was present during the procedure were all recorded.
There were 15 patients included within our case series (69.5, 4 F). There were no reported intraoperative vascular or neurological complications in 15 cases. The operative time for the cases ranged from 2.7 to 8.4 hours (average=5.2±1.9 h). The average lordosis gained at L5-S1 was 8.6±3.0 degrees and the average lumbar lordosis gained was 14.7±6.4 degrees. The average PI-LL mismatch went from 22.4±13.3 degrees preoperative to 7.8±10.2 degrees postoperative. One patient had a postoperative complication of a sacral fracture requiring placement of a pelvic screw for a L2-pelvis fusion. There were 8 patients with 4+ levels of fusion. For this cohort of patients, the average lumbar lordosis gained was 16.0±7.5 degrees and the average PI-LL mismatch went from 24.7±16.3 degrees preoperative to 8.8±12.9 degrees postoperative. For the patients with 4+ levels of fusion, the average operative time was 5.9±1.8 hours.
We have described our early positive results with simultaneous LLIF/ALIF surgery for treatment of lumbar degenerative conditions.
手术技术描述和回顾性研究。
描述一种用于多节段腰椎融合的新手术技术，并介绍早期临床结果。
患有多节段腰椎管狭窄症和成人退行性脊柱侧凸的患者通常需要多节段椎间置入以实现间接减压和脊柱前凸。我们描述了一系列接受同时侧方腰椎椎间融合术（LLIF）和前路腰椎椎间融合术（ALIF）治疗 L5-S1 的患者病例系列。
我们回顾性分析了一组连续接受多节段腰椎管狭窄症治疗的患者，这些患者同时接受 ALIF 和 LLIF 融合，且至少随访 3 个月。所有患者均接受双侧经皮椎弓根螺钉补充固定。我们在术前 X 线片上测量了腰椎前凸角、骨盆入射角和 L5-S1 前凸角。记录了手术的术中因素，如手术时间、估计失血量、提供的液体量、融合的节段数以及手术过程中是否有学员在场。
我们的病例系列中包括 15 名患者（69.5%，4 名女性）。15 例均未报告术中血管或神经并发症。病例的手术时间为 2.7 至 8.4 小时（平均=5.2±1.9 小时）。L5-S1 获得的平均前凸角为 8.6±3.0 度，平均腰椎前凸角增加 14.7±6.4 度。术前平均骨盆入射角-腰椎前凸角差值为 22.4±13.3 度，术后为 7.8±10.2 度。1 例患者术后发生骶骨骨折，需要放置 L2-骨盆螺钉进行 L2-骨盆融合。有 8 名患者融合了 4 个以上节段。对于这组患者，平均腰椎前凸角增加了 16.0±7.5 度，术前平均骨盆入射角-腰椎前凸角差值为 24.7±16.3 度，术后为 8.8±12.9 度。对于融合 4 个以上节段的患者，平均手术时间为 5.9±1.8 小时。
我们描述了同时进行 LLIF/ALIF 手术治疗腰椎退行性疾病的早期积极结果。
