Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Gyeonggi Province, South Korea.
Spine (Phila Pa 1976). 2022 Nov 15;47(22):1583-1589. doi: 10.1097/BRS.0000000000004433. Epub 2022 Jul 15.
Retrospective radiological analysis.
To demonstrate the radiological outcome after a modified anterior column realignment (mACR) with partial anterior longitudinal ligament (ALL) release in oblique lateral interbody fusion (OLIF).
Anterior column realignment (ACR) remains a powerful sagittal correction technique in minimally invasive adult spinal deformity surgery and is often combined with posterior column osteotomy (PCO) to achieve more lordosis. OLIF is ideal for ACR because the anterior-to-psoas corridor typically involves the anterolateral half of the disk.
This study included 112 operated disk levels of 101 consecutive patients who underwent OLIF between L2-L3 and L4-L5 using a 12° lateral cage. The mACR was performed at 73 (65.2%) levels with 30% to 50% sectioning of the ALL. Each operated level was grouped according to the mACR and additional PCO as: (1) no mACR, OLIF only (n=39); (2) mACR with no PCO (n=18); (3) mACR with grade 1 PCO (n=27); (4) mACR with grade 2 PCO (n=22); or (5) mACR with grade 3 PCO (n=6).
At the last follow-up, the mean disk lordotic angles were 10.9±2.9°, 12.6±3.0°, 13.3±3.9°, 16.7±3.2°, and 16.8±2.4° in the no mACR, mACR with no PCO, mACR with grade 1 PCO, mACR with grade 2 PCO, and mACR with grade 3 PCO groups, respectively ( P <0.001). The mean increases in disk lordotic angle were 5.8±4.1°, 12.1±6.1°, 13.5±8.7°, 15.8±6.7°, and 17.9±6.2° in each group, respectively ( P <0.001).
ACR can be performed with partial ALL release under direct vision in OLIF without deep dissection into the ventral disk space. The mACR in OLIF is a simple, safe, and effective technique for anterior column lengthening.
研究设计：回顾性影像学分析。
目的：展示改良前柱矫正（mACR）联合部分前纵韧带（ALL）松解在斜侧前路椎间融合术（OLIF）中的影像学结果。
背景资料概要：前柱矫正（ACR）仍然是微创成人脊柱畸形手术中一种强大的矢状面矫正技术，通常与后柱截骨术（PCO）联合应用以获得更多的前凸。OLIF 非常适合 ACR，因为前至腰大肌通道通常涉及椎间盘的前外侧半。
方法：本研究纳入了 101 例连续接受 L2-L3 和 L4-L5 12°侧方椎间融合器（cage）OLIF 手术的患者的 112 个手术节段。73 个节段（65.2%）行 mACR，ALL 切除 30%-50%。根据 mACR 和附加 PCO，每个手术节段分为以下几组：（1）无 mACR，仅行 OLIF（n=39）；（2）行 mACR 但无 PCO（n=18）；（3）行 mACR 伴 1 级 PCO（n=27）；（4）行 mACR 伴 2 级 PCO（n=22）；或（5）行 mACR 伴 3 级 PCO（n=6）。
结果：末次随访时，无 mACR、mACR 伴无 PCO、mACR 伴 1 级 PCO、mACR 伴 2 级 PCO 和 mACR 伴 3 级 PCO 组的椎间盘前凸角分别为 10.9°±2.9°、12.6°±3.0°、13.3°±3.9°、16.7°±3.2°和 16.8°±2.4°（P<0.001）。各组椎间盘前凸角的平均增加量分别为 5.8°±4.1°、12.1°±6.1°、13.5°±8.7°、15.8°±6.7°和 17.9°±6.2°（P<0.001）。
结论：OLIF 中可在直视下经部分 ALL 松解行 ACR，无需深入腹侧椎间盘间隙进行深部解剖。OLIF 中的 mACR 是一种简单、安全、有效的前柱延长技术。
证据等级：4 级。
