Instituto de Patologia da Coluna, São Paulo, SP, Brazil.
Eur Spine J. 2023 May;32(5):1655-1677. doi: 10.1007/s00586-023-07619-2. Epub 2023 Mar 14.
The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF.
This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample.
Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05).
Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.
侧方腰椎椎间融合术作为一种治疗多种脊柱疾病的革命性方法出现，因为该技术能够通过微创的方法促进间接减压和脊柱前凸恢复，从而减少出血量并使患者更快恢复。然而，目前尚不清楚该技术与 TLIF、PLIF 和 PLF 等其他已确立的治疗脊柱退行性疾病的方法相比如何。
这是一项对过去 10 年中比较侧方入路与后路技术的文章进行的系统评价和荟萃分析。作者纳入了比较 LLIF 技术与一种或多种后路技术、仅治疗退行性病变且至少包含研究的一个关键结果的文章。排除了非原创性的文章和作者无法获取全文的文章；还排除了无法计算标准差或平均值的文章。对于计数变量，使用比值比；对于连续变量，使用标准均数差值（SMD），并根据样本中是否存在显著（p < 0.05）异质性来选择随机或固定效应模型。
共有 24 篇文章纳入定量综述。就围手术期变量而言，侧方入路组在术中出血量（SMD=-1.56，p<0.001）和手术时间（SMD=-0.33，p=0.24）方面有显著降低。此外，侧方入路组的住院天数有减少的趋势（SMD=-0.15，p=0.09），并发症的比值比显著降低（0.53，p=0.01）。在临床结果方面，两种方法在改善 ODI 和 VAS-BP 方面都有相似的改善，无论是在改善方面还是在最后随访值方面。最后，当分析节段前凸和腰椎前凸的变化时，侧方技术在这两种结果上都显著促进了更高的矫正（p<0.05）。
侧方入路可以促进显著的影像学矫正和相似的临床改善，同时减少手术出血量和术后并发症。
