Kaul Rahul, Kumar Khemendra, Jeyaraman Madhan, Goswami Bharat, Choudhary Milind Chandra, Chhabra H S, Kumar Sudhir
Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh India.
Department of Radio-Diagnosis, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh India.
Indian J Orthop. 2021 Apr 7;55(Suppl 2):366-373. doi: 10.1007/s43465-021-00393-7. eCollection 2021 Jul.
The novel Oblique lumbar interbody fusion [OLIF] technique has been proposed as a solution to approach related complications of anterior lumbar interbody fusion [ALIF] and lateral lumbar interbody fusion [LLIF]. There exists no study concerning morphological evaluation of retroperitoneal oblique corridor for the Oblique lumbar interbody fusion (OLIF) technique in the Indian population. The aim of our study was (a) to measure magnetic resonance imaging (MRI) based anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 level (b) to determine the feasibility of this technique following MRI-based morphometric evaluation in the Indian population.
We did retrospective MRI analysis of 307 consecutive patients following our exclusion criteria. Bare window, psoas major window and psoas major width were measured from axial T2 MRI image taken at mid disc level from L2-L3 to L4-L5 levels.
The mean bare window size was largest at L2-L3 (1.39 cm) level followed by L3-L4 and L4-L5 level (1.28 and 0.62 cm respectively), and differences between them were statistically significant ( < 0.001). Females had statistically significant larger bare windows at L2-L3 and L3-L4 level than males ( < 0.001). With increasing age, there was a significant increase in bare window size at each level ( < 0.001). The mean psoas major window (PM and mean psoas major width (PM were largest at L4-L5 level (PM = 1.27 cm, PM = 3.61 cm) followed by L3-L4 and L2-L3 level (L3-L4: PM = 1.19 cm, PM = 2.36 cm; L2-L3: PM = 0.88 cm, PM = 1.39 cm), and differences among each level concerning both parameters were statistically significant ( < 0.001). Both parameters (PM, PM) were significantly larger in males than females at each level ( < 0.001).
The OLIF technique is well suited for lumbar interbody fusion at L2 -L3 and L3-L4 level in the Indian population irrespective of age and sex. At L4-L5 level, overall 17.9 percent of the study population were unsuitable for this technique due to inaccessible bare window. In our opinion, this level may be better suited for OLIF approach in the elderly Indian population, especially for surgeons who are beginning to attempt this technique in their surgical practice. Preoperative MRI evaluation for the OLIF is important to assess its feasibility, as there exists significant age and gender differences in the Indian population for anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 levels.
The online version contains supplementary material available at 10.1007/s43465-021-00393-7.
新型斜外侧腰椎椎间融合术（OLIF）已被提出，作为解决前路腰椎椎间融合术（ALIF）和外侧腰椎椎间融合术（LLIF）相关入路并发症的一种方法。在印度人群中，尚无关于斜外侧腰椎椎间融合术（OLIF）技术的腹膜后斜行通道形态学评估的研究。我们研究的目的是：（a）测量基于磁共振成像（MRI）的从L2-L3至L4-L5节段OLIF手术窗口的解剖学参数；（b）在印度人群中，基于MRI形态学评估确定该技术的可行性。
我们按照排除标准对307例连续患者进行了回顾性MRI分析。从L2-L3至L4-L5节段椎间盘水平的轴向T2加权MRI图像上测量裸区窗口、腰大肌窗口和腰大肌宽度。
平均裸区窗口大小在L2-L3节段最大（1.39cm），其次是L3-L4节段和L4-L5节段（分别为1.28cm和0.62cm），它们之间的差异具有统计学意义（P<0.001）。在L2-L3和L3-L4节段，女性的平均裸区窗口显著大于男性（P<0.001）。随着年龄的增加，每个节段的裸区窗口大小均显著增加（P<0.001）。平均腰大肌窗口（PM）和平均腰大肌宽度（PW）在L4-L5节段最大（PM = 1.27cm，PW = 3.61cm），其次是L3-L4节段和L2-L3节段（L3-L4：PM = 1.19cm，PW = 2.36cm；L2-L3：PM = 0.88cm，PW = 1.39cm），各节段这两个参数之间的差异均具有统计学意义（P<0.001）。在每个节段，男性的这两个参数（PM、PW）均显著大于女性（P<0.001）。
在印度人群中，无论年龄和性别，OLIF技术都非常适合L2-L3和L3-L4节段的腰椎椎间融合。在L4-L5节段，由于裸区窗口难以到达，总体17.9%的研究人群不适合该技术。我们认为，在印度老年人群中，这个节段可能更适合OLIF入路，特别是对于刚开始在手术实践中尝试该技术的外科医生。术前对OLIF进行MRI评估对于评估其可行性很重要，因为在印度人群中，从L2-L3至L4-L5节段OLIF手术窗口的解剖学参数存在显著的年龄和性别差异。
在线版本包含可在10.1007/s43465-021-00393-7获取的补充材料。
