Biocor/ Vila da Serra Hospital, Columna Institute, Belo Horizonte, Brazil.
Department of Orthopedic Surgery and Neurosurgery, Stanford University Medical Center, Redwood City, CA, USA.
Eur Spine J. 2022 Sep;31(9):2270-2278. doi: 10.1007/s00586-022-07319-3. Epub 2022 Jul 22.
Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF).
A two-round Delphi method study was conducted to assess the consensus, within expert spine surgeons, regarding the perception of safety, the preoperative planning, the complications management and the need for vascular surgeons by performing anterior approaches (SupALIF vs LatALIF).
A total of 14 experts voluntary were involved in the survey. From 82 sentences voted in the first round, a consensus was reached for 38 items. This included the feasibility of safe LatALIF without systematic involvement of vascular surgeon for routine cases (while for revision cases the involvement of the vascular surgeon is an appropriate option) and the appropriateness of standard MRI to evaluate the accessibility of the vascular window. Thirteen sentences reached the final consensus in the second round, whereas no consensus was reached for the remaining 20 statements.
The Delphi study collected the consensus on several points, such as the consolidated required experience on anterior approaches, the accurate study of vascular anatomy with MRI, the management of complications and the significant reduction of the surgical times of the LatALIF if compared to SupALIF in combined procedures. Furthermore, the study group agrees that LatALIF can be performed without the need for a vascular surgeon in routine cases.
对于需要椎间稳定性、脊柱畸形矫正或大面积融合的临床情况，建议采用前路腰椎入路。侧卧位前路腰椎体间融合术（LatALIF）近年来受到越来越多的关注。本研究旨在通过比较 LatALIF 与标准 L5-S1 仰卧位前路腰椎体间融合术（SupALIF），描述血管外科医生根据经验丰富的脊柱外科医生的当前习惯、对安全性的认知以及对血管外科医生需求的认知。
采用两轮 Delphi 法研究，评估专家脊柱外科医生对安全性感知、术前规划、并发症管理以及进行前路入路（SupALIF 与 LatALIF）时对血管外科医生需求的共识。
共有 14 名专家自愿参与了这项调查。在第一轮投票的 82 个句子中，有 38 个达成了共识。这包括在常规情况下，安全进行 LatALIF 的可行性，无需系统地涉及血管外科医生（而对于翻修病例，涉及血管外科医生是一个合适的选择），以及标准 MRI 评估血管窗可及性的适宜性。第二轮达成了共识的句子有 13 个，而其余 20 个句子则未达成共识。
Delphi 研究收集了一些方面的共识，例如对前路入路的综合经验要求、MRI 对血管解剖结构的精确研究、并发症的处理以及在联合手术中与 SupALIF 相比 LatALIF 手术时间的显著缩短。此外，研究小组认为，在常规病例中，LatALIF 可以在无需血管外科医生的情况下进行。
