Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
BMC Musculoskelet Disord. 2022 Mar 14;23(1):245. doi: 10.1186/s12891-022-05204-0.
Lateral interbody release (LIR) via a transpsoas lateral approach is a surgical strategy to address degenerative lumbar scoliosis (DLS) patients with anterior autofusion of vertebral segments. This study aimed to characterize the clinical and radiographic outcomes of this lumbar reconstruction strategy using LIR to achieve anterior column correction.
Data for 21 fused vertebrae in 17 consecutive patients who underwent LIR between January 2014 and March 2020 were reviewed. Demographic and intraoperative data were recorded. Radiographic parameters were assessed preoperatively and at final follow-up, including segmental lordotic angle (SLA), segmental coronal angle (SCA), bone union rate, pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt, sacral slope, PI-LL mismatch, sagittal vertical axis, Cobb angle, and deviation of the C7 plumb line from the central sacral vertical line. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analog scale (VAS) scores for low back and leg pain, and the short form 36 health survey questionnaire (SF-36) postoperatively and at final follow-up. Complications were also assessed.
Mean patient age was 70.3 ± 4.8 years and all patients were female. Average follow-up period was 28.4 ± 15.3 months. Average procedural time to perform LIR was 21.3 ± 9.7 min and was not significantly different from traditional lateral interbody fusion at other levels. Blood loss per single segment during LIR was 38.7 ± 53.2 mL. Fusion rate was 100.0% in this cohort. SLA improved significantly from - 7.6 ± 9.2 degrees preoperatively to 7.0 ± 8.8 degrees at final observation and SCA improved significantly from 19.1 ± 7.8 degrees preoperatively to 8.7 ± 5.9 degrees at final observation (P < 0.0001, and < 0.0001, respectively). All spinopelvic and coronal parameters, as well as ODI and VAS, improved significantly. Incidence of peri- and postoperative complications such as iliopsoas muscle weakness and leg numbness in patients who underwent LIR was as much as XLIF. Incidence of postoperative mechanical failure following LIR was also similar to XLIF. Reoperation rate was 11.8%. However, there were no reoperations associated with LIR segments.
The LIR technique for anterior column realignment of fused vertebrae in the context of severe ASD may be an option of a safe and effective surgical strategy.
通过经椎间孔侧方入路进行侧方椎间松解术（LIR）是一种治疗具有前方椎体融合的退行性腰椎侧凸（DLS）患者的手术策略。本研究旨在通过 LIR 实现前方柱矫正，来描述这种腰椎重建策略的临床和影像学结果。
回顾了 2014 年 1 月至 2020 年 3 月期间接受 LIR 的 17 例连续患者的 21 个融合椎体的数据。记录了人口统计学和术中数据。术前和末次随访时评估影像学参数，包括节段性脊柱前凸角（SLA）、节段性冠状角（SCA）、骨融合率、骨盆入射角（PI）、腰椎前凸（LL）、骨盆倾斜度、骶骨倾斜度、PI-LL 不匹配、矢状垂直轴、Cobb 角和 C7 铅垂线与正中骶骨垂直线的偏差。术后和末次随访时，采用 Oswestry 残疾指数（ODI）、腰痛和腿痛视觉模拟量表（VAS）评分以及简明 36 健康调查量表（SF-36）评估临床结果。还评估了并发症。
患者平均年龄为 70.3±4.8 岁，均为女性。平均随访时间为 28.4±15.3 个月。进行 LIR 的平均手术时间为 21.3±9.7 分钟，与其他水平的传统侧方椎间融合术相比并无显著差异。LIR 单节段的出血量为 38.7±53.2ml。本队列的融合率为 100.0%。SLA 从术前的-7.6±9.2 度显著改善至末次观察时的 7.0±8.8 度，SCA 从术前的 19.1±7.8 度显著改善至末次观察时的 8.7±5.9 度（P<0.0001 和 P<0.0001）。所有脊柱骨盆和冠状参数以及 ODI 和 VAS 均显著改善。行 LIR 的患者，包括髂腰肌无力和下肢麻木在内的围手术期并发症的发生率与 XLIF 相当。LIR 后发生机械性失败的发生率也与 XLIF 相似。再手术率为 11.8%。然而，没有与 LIR 节段相关的再手术。
在严重 ASD 背景下，用于融合椎体前方柱矫正的 LIR 技术可能是一种安全有效的手术策略选择。
