Li Zhen-Zhou, Wang Jin-Chang, Cao Zheng, Zhao Hong-Liang, Lewandrowski Kai-Uwe, Yeung Anthony
Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Arizona; Visiting Professor Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia; and Department of Neurosurgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Int J Spine Surg. 2021 Jun;15(3):504-513. doi: 10.14444/8072. Epub 2021 May 7.
Oblique lateral lumbar interbody fusion (OLLIF) is a minimally invasive lumbar interbody fusion procedure using a bullet-shaped polyetheretherketone (PEEK) nonexpandable fusion cage modified to diminish risk to the exiting nerve root during posterolateral implantation through the Kambin safe zone under fluoroscopic guidance. The objective of this study was to present feasibility of this procedure and 1-year clinical outcome data.
The authors present a prospective cohort study of 20 patients who underwent fluoroscopy-guided and full-endoscopic OLLIF in 22 segments allowing protection of the exiting nerve root from January 2018 to March 2019. The foraminoplasty, discectomy, endplate preparation, placement of bone graft and insertion of the fusion cage was done under continuous full-endoscopic visualization. The OLLIF fusion was backed up with bilateral percutaneous posterior supplemental pedicle screw fixation. Primary clinical outcome measures were the visual analog scale (VAS) of low back and leg pain, and Oswestry disability index (ODI) at 1 week, 3 months, 6 months, and 1 year after the operation. At final follow-up, the Macnab score was also evaluated. Secondary outcome measures were computed tomography (CT) assessment fusion using the Mannion classification of spinal fusion and adverse events related to the device as well as magnetic resonance imaging (MRI) assessment of nerve root decompression.
All patients had significant relief of low back pain and leg pain, by VAS and ODI scores that improved significantly ( < .01). There were no complications. Postoperative lumbar MRI of all patients showed sufficient direct nerve decompression. At 1-year follow-up, excellent Macnab outcomes were obtained 13 patients, good in six, and fair in one. Impaired sensation and muscle strength of the involved nerve root significantly recovered in all but 2 patients ( < .05). According to the Mannion CT-based classification of spinal fusion, CT showed complete interbody fusion achieved in all 22 segments.
Full-endoscopic OLLIF is a safe, effective, minimally invasive, economical, practical, and widely applicable minimally invasive interbody fusion technique in the lumbar spine.
斜外侧腰椎椎间融合术（OLLIF）是一种微创腰椎椎间融合手术，使用一种子弹形聚醚醚酮（PEEK）非扩张性融合器，该融合器经过改良，以降低在荧光透视引导下经Kambin安全区进行后外侧植入时对出口神经根的风险。本研究的目的是介绍该手术的可行性及1年的临床结果数据。
作者对20例患者进行了一项前瞻性队列研究，这些患者在2018年1月至2019年3月期间接受了荧光透视引导下的全内镜OLLIF手术，共22节段，可保护出口神经根。椎间孔成形术、椎间盘切除术、终板准备、植骨放置和融合器插入均在持续全内镜直视下进行。OLLIF融合术辅以双侧经皮后路补充椎弓根螺钉固定。主要临床结局指标为术后1周、3个月、6个月和1年时的腰腿痛视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）。在最终随访时，还评估了Macnab评分。次要结局指标包括使用Mannion脊柱融合分类法进行的计算机断层扫描（CT）评估融合情况、与器械相关的不良事件以及神经根减压的磁共振成像（MRI）评估。
所有患者的腰腿痛均有显著缓解，VAS和ODI评分显著改善（P <.01）。无并发症发生。所有患者术后腰椎MRI均显示神经根直接减压充分。在1年随访时，13例患者获得了优秀的Macnab结果，6例为良好，1例为一般。除2例患者外，所有患者受累神经根的感觉和肌力受损均有显著恢复（P <.05）。根据基于Mannion CT的脊柱融合分类法，CT显示所有22节段均实现了椎间融合。
全内镜OLLIF是一种安全、有效、微创、经济、实用且广泛适用的腰椎微创椎间融合技术。
3级。
