Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Clin Spine Surg. 2023 Aug 1;36(7):E294-E299. doi: 10.1097/BSD.0000000000001367. Epub 2022 Aug 10.
This was a retrospective comparative study.
To compare the likelihood of approach-related complications for patients undergoing single-level lateral lumbar interbody fusion (LLIF) at L4-L5 to those undergoing the procedure at upper lumbar levels.
LLIF has been associated with a number of advantages when compared with traditional interbody fusion techniques. However, potential risks with the approach include vascular or visceral injury, thigh dysesthesias, and lumbar plexus injury. There are concerns of a higher risk of these complications at the L4-L5 level compared with upper lumbar levels.
A retrospective cohort review was completed for consecutive patients undergoing single-level LLIF between 2004 and 2019 by a single surgeon. Indication for surgery was symptomatic degenerative lumbar stenosis and/or spondylolisthesis. Patients were divided into 2 cohorts: LLIF at L4-L5 versus a single level between L1 and L4. Baseline characteristics, intraoperative complications, postoperative approach-related neurological symptoms, and patient-reported outcomes were compared and analyzed between the cohorts.
A total of 122 were included in analysis, of which 58 underwent LLIF at L4-L5 and 64 underwent LLIF between L1 and L4. There were no visceral or vascular injuries or lumbar plexus injuries in either cohort. There was no significant difference in the rate of postoperative hip pain, anterior thigh dysesthesias, and/or hip flexor weakness between the cohorts (53.5% L4-L5 vs. 37.5% L1-L4; P =0.102). All patients reported complete resolution of these symptoms by 6-month postoperative follow-up.
LLIF surgery at the L4-L5 level is associated with a similar infrequent likelihood of approach-related complications and postoperative hip pain, thigh dysesthesias, and hip flexor weakness when compared with upper lumbar level LLIF. Careful patient selection, meticulous use of real-time neuromonitoring, and an understanding of the anatomic location of the lumbar plexus to the working corridor are critical to success.
这是一项回顾性对比研究。
比较行单节段侧方腰椎间融合术（LLIF）治疗 L4-L5 与治疗上腰椎患者的相关并发症发生概率。
与传统椎间融合技术相比，LLIF 具有许多优势。然而，该入路的潜在风险包括血管或内脏损伤、大腿感觉异常和腰丛损伤。与上腰椎相比，人们担心 L4-L5 水平发生这些并发症的风险更高。
对 2004 年至 2019 年间由同一位外科医生连续进行单节段 LLIF 的患者进行了回顾性队列研究。手术指征为症状性退行性腰椎狭窄症和/或腰椎滑脱症。患者分为两组：L4-L5 节段的 LLIF 与 L1-L4 之间的单节段 LLIF。比较和分析两组间的基线特征、术中并发症、术后与入路相关的神经症状和患者报告的结果。
共有 122 例患者纳入分析，其中 58 例接受 L4-L5 节段的 LLIF，64 例接受 L1-L4 节段的 LLIF。两组均无内脏或血管损伤或腰丛损伤。两组术后髋关节疼痛、大腿前感觉异常和/或髋关节屈肌无力的发生率无显著差异（53.5% L4-L5 与 37.5% L1-L4；P=0.102）。所有患者在术后 6 个月随访时均报告完全缓解这些症状。
与上腰椎节段的 LLIF 相比，L4-L5 节段的 LLIF 手术与相似的罕见相关并发症和术后髋关节疼痛、大腿感觉异常和髋关节屈肌无力相关。仔细的患者选择、实时神经监测的精心使用以及对腰丛在工作通道的解剖位置的理解是成功的关键。
