Tseng Sheng-Chieh, Lin Yu-Hsien, Wu Yun-Che, Shih Cheng-Min, Chen Kun-Hui, Lee Cheng-Hung, Pan Chien-Chou
Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Physical Therapy, HungKuang University, Taichung, Taiwan.
Front Surg. 2022 Aug 18;9:911514. doi: 10.3389/fsurg.2022.911514. eCollection 2022.
Oblique lumbar interbody fusion (OLIF) is a popular technique for the treatment of degenerative lumbar spinal disease. There are no clear guidelines on whether direct posterior decompression (PD) is necessary after OLIF. The purpose of this study was to analyze the effect of the indirect decompression obtained from OLIF in patients with lumbar foraminal stenosis. We retrospectively reviewed 33 patients who underwent OLIF surgery for degenerative lumbar spinal disease between 1 January 2018, and 30 June 2019. The inclusion criteria included patients who were diagnosed with lumbar foraminal stenosis by preoperative MRI. The exclusion criteria included the presence of central canal stenosis, spinal infection, vertebral fractures, and spinal malignancies. The clinical results, evaluated using the visual analogue scale of back pain (VAS-Back), VAS of leg pain (VAS-Leg), and Oswestry disability index (ODI), were recorded. The radiologic parameters were also measured. The VAS-Back, VAS-Leg, and ODI showed significant improvement in both the PD and non-posterior decompression (Non-PD) groups postoperatively (all, < 0.05). Patients in the Non-PD group showed better results than those in the PD group in the VAS-Back at 12- and 24 months postoperatively (0.00 vs. 3.00 postoperatively at 12 months, = 0.030; 0.00 vs. 4.00 postoperatively at 24 months, = 0.009). In addition, the ODI at 24 months postoperatively showed better improvement in the Non-PD group (8.89 vs. 24.44, = 0.038). The disc height in both the PD and the Non-PD groups increased significantly postoperatively (all, < 0.05), but the restoration of foraminal height was significantly different only in the Non-PD group. There was no statistically significant difference in cage position, cage subsidence, fusion grade, or screw loosening between the PD and the Non-PD groups. Indirect decompression OLIF for lumbar foraminal stenosis showed favorable outcomes. The use of interbody cages and posterior instrumentation was sufficient for relieving symptoms in patients with lumbar foraminal stenosis. Additional direct posterior decompression may deteriorate results in the follow-up period.
斜外侧腰椎椎间融合术（OLIF）是治疗退行性腰椎疾病的一种常用技术。对于OLIF术后是否需要直接后路减压（PD），目前尚无明确的指导原则。本研究的目的是分析OLIF间接减压对腰椎椎间孔狭窄患者的疗效。我们回顾性分析了2018年1月1日至2019年6月30日期间因退行性腰椎疾病接受OLIF手术的33例患者。纳入标准包括术前MRI诊断为腰椎椎间孔狭窄的患者。排除标准包括存在中央椎管狭窄、脊柱感染、椎体骨折和脊柱恶性肿瘤。记录采用背痛视觉模拟量表（VAS-Back）、腿痛视觉模拟量表（VAS-Leg）和Oswestry功能障碍指数（ODI）评估的临床结果。同时测量影像学参数。术后PD组和非后路减压（Non-PD）组的VAS-Back、VAS-Leg和ODI均有显著改善（均P＜0.05）。Non-PD组患者术后12个月和24个月的VAS-Back结果优于PD组（术后12个月：0.00对3.00，P = 0.030；术后24个月：0.00对4.00，P = 0.009）。此外，术后24个月Non-PD组的ODI改善情况更好（8.89对24.44，P = 0.038）。PD组和Non-PD组术后椎间盘高度均显著增加（均P＜0.05），但仅Non-PD组椎间孔高度恢复有显著差异。PD组和Non-PD组在椎间融合器位置、椎间融合器下沉、融合等级或螺钉松动方面无统计学显著差异。OLIF间接减压治疗腰椎椎间孔狭窄显示出良好的效果。椎间融合器和后路内固定器械的使用足以缓解腰椎椎间孔狭窄患者的症状。额外的直接后路减压可能会使随访期的结果恶化。
