Midland Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly, R35 NY51, Ireland.
University College Dublin, Belfield, Dublin 4, Ireland.
Acta Neurochir (Wien). 2021 Nov;163(11):2991-3004. doi: 10.1007/s00701-021-05000-0. Epub 2021 Sep 21.
Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type.
A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach.
A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = - 0.04-0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).
Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.
前路腰椎体间融合术（ALIF）是一种成熟的后路椎体间融合技术的替代方法，其入路方式有多种，如腹膜后入路、腹腔入路、开放入路和腹腔镜入路等，这些方法都有详细的描述。文献中列举了每种方法的并发症发生率。本研究旨在阐明不同入路方式的并发症发生率。
通过对 PubMed、Google Scholar 和 OVID Medline 搜索数据库进行系统回顾，确定了与并发症相关的 ALIF 研究。本研究采用 PRISMA 指南进行综述。采用荟萃分析比较了每种入路方式的术中及术后并发症。
共确定了 4575 项研究，应用纳入和排除标准后，有 31 项研究的 5728 例患者纳入综述。荟萃分析表明，腹腔入路的逆行射精（RE）发生率更高（p<0.001；CI=0.05-0.21），总体并发症发生率更高（p=0.05；CI=0.00-0.23）。在 L5/S1 椎间水平，RE 的发生率更高。两种入路方法的血管损伤发生率均无显著差异（p=0.89；CI=−0.04-0.07）。内脏损伤的发生率似乎与入路方法无关。腹腔镜入路的住院时间更短（p=0.01）。
尽管腹膜后入路的病例数相对较少，但它的使用似乎导致了更高的术中及术后并发症发生率，尽管应考虑骨形态发生蛋白（BMP）的使用和脊柱水平等混杂因素。腹腔镜入路的住院时间更短；然而，其陡峭的学习曲线和较长的手术时间阻碍了外科医生广泛采用这种方法。
