Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopedics, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand.
World Neurosurg. 2022 Apr;160:e322-e327. doi: 10.1016/j.wneu.2022.01.011. Epub 2022 Jan 10.
To compare location and amount of unremoved intervertebral disc between extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF).
Postoperative magnetic resonance images of patients who underwent XLIF and OLIF for degenerative spine diseases were reviewed. An axial cut T2-weighted image that was the middle cut of operated disc space was selected. We divided the disc area into 5 zones: central, left anterior, left posterior, right anterior, and right posterior. Disc area was measured using a picture archiving and communication system program. The angle of intervertebral cage was also measured.
A total of 61 levels of XLIF from 51 patients and 62 levels of OLIF from 34 patients were included. The area of unremoved disc at left anterior, right anterior, and left posterior zones of OLIF were significantly greater than XLIF (55.7 ± 41.5 vs. 29.8 ± 33.3 mm, 57.9 ± 43.6 vs. 34.1 ± 33.1 mm, and 50.5 ± 41.8 vs. 31.5 ± 35.9 mm, respectively; P < 0.01). No significant differences were found at the right posterior and central zones. A 9.2° ± 6.1° and 0.7° ± 4.9° cage angulation from left anterior to right posterior was found in OLIF and XLIF, respectively, with statistical significance.
Our study found a greater area of unremoved disc in OLIF compared with XLIF. The common locations were in the contralateral side of the surgical approach-right anterior in OLIF, and right posterior in XLIF. The greater area of the unremoved disc in the anterior zone after OLIF due to oblique corridor to disc space may cause cage malposition. Meticulous disc removal should be performed, especially in OLIF, to prevent complications.
比较极外侧腰椎间融合术（XLIF）和斜外侧腰椎间融合术（OLIF）的椎间盘残留位置和残留量。
回顾退行性脊柱疾病行 XLIF 和 OLIF 治疗的患者的术后磁共振图像。选择手术椎间盘间隙的中间轴位 T2 加权像。我们将椎间盘区域分为 5 个区：中央区、左前区、左后区、右前区和右后区。使用图像存档和通信系统程序测量椎间盘面积。还测量了椎间笼的角度。
共纳入 51 例患者的 61 个 XLIF 节段和 34 例患者的 62 个 OLIF 节段。OLIF 的左前区、右前区和左后区未切除椎间盘面积明显大于 XLIF（55.7 ± 41.5 与 29.8 ± 33.3 mm，57.9 ± 43.6 与 34.1 ± 33.1 mm，50.5 ± 41.8 与 31.5 ± 35.9 mm；P < 0.01）。右后区和中央区无显著差异。OLIF 和 XLIF 的椎间笼从左前到右后的角度分别为 9.2° ± 6.1°和 0.7° ± 4.9°，具有统计学意义。
我们的研究发现 OLIF 比 XLIF 有更大的椎间盘残留面积。常见部位在手术入路的对侧-OLIF 的右侧前区，XLIF 的右侧后区。OLIF 斜向进入椎间盘间隙可能导致前区残留椎间盘面积较大，从而导致椎间笼位置不正。应仔细切除椎间盘，特别是在 OLIF 中，以预防并发症。
