Ricciardi Luca, Piazza Amedeo, Capobianco Mattia, Della Pepa Giuseppe Maria, Miscusi Massimo, Raco Antonino, Scerrati Alba, Somma Teresa, Lofrese Giorgio, Sturiale Carmelo Lucio
Department of NESMOS, Operative Unit of Neurosurgery, AOSA, Sapienza, Rome, Italy.
Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.
Eur J Orthop Surg Traumatol. 2023 Jan;33(1):1-7. doi: 10.1007/s00590-021-03172-0. Epub 2021 Nov 26.
Systematic review and meta-analysis.
Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels.
The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications.
After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group.
The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
系统评价与荟萃分析。
从历史上看，腰椎后路手术使外科医生能够处理影响腰椎的退行性疾病。然而，脊柱肌肉损伤、术后椎体不稳定、脑脊液（CSF）漏以及腰椎手术失败综合征（FBSS）是这些手术后可能发生的严重并发症。如果需要进行单节段或多节段融合，采用前路（ALIF）、斜外侧（OLIF）或外侧（LLIF）入路的腰椎椎间融合术可能是有价值的手术替代方案。
本研究是一项根据PRISMA声明进行的系统评价，纳入了关于OLIF和LLIF治疗退行性脊柱疾病的比较研究，并对其临床影像学结果和并发症进行荟萃分析。
在对PubMed、Scopus和Cochrane图书馆的1472篇论文进行筛选后，本研究仅纳入3篇论文。纳入318例患者进行数据荟萃分析，OLIF组128例，LLIF组190例。在手术（术中失血和手术时间）和临床（腰部视觉模拟评分、腿部视觉模拟评分和ODI评分）结果或末次随访（>2年）时的融合率方面，两组无显著差异。OLIF组腹部并发症、系统故障和血管损伤的发生率显著更高。相反，LLIF组术后神经症状和腰大肌无力明显更常见。
荟萃分析表明，OLIF和LLIF治疗腰椎退行性疾病均有效，尽管它们各自存在特定的并发症，这在手术规划中应是一个重要因素。
