改良斜外侧腰椎椎间融合术：在直接显微镜视野下建立暴露的更好方法。

A modified oblique lumbar interbody fusion: A better way to establish an exposure under direct microscopic vision.

作者信息

Wang Kai, Zhang Xiangyu, Zhao Zirun, Chou Dean, Jian Fengzeng, Wu Hao

机构信息

Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China.

Department of Radiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States.

出版信息

Front Surg. 2023 Mar 6;10:1130489. doi: 10.3389/fsurg.2023.1130489. eCollection 2023.

DOI:10.3389/fsurg.2023.1130489

PMID:36950057

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10025467/

Abstract

STUDY DESIGN

This is a retrospective study.

OBJECTIVE

To demonstrate a modified oblique lumbar interbody fusion (OILF) technique for L1-L5.

METHODS

The modified technique splits anterior portion of psoas belly to access the oblique corridor (OC) anteroinferior to psoas, minimizing psoas manipulation and retraction and avoiding nerve injury while offering excellent microscopic visualization. Psoas weakness and neurovascular complication rates in patients treated with traditional OLIF (T-OLIF) or anteroinferior psoas OLIF (AP-OLIF) were retrospectively reviewed. Clinical outcomes were also reviewed.

RESULTS

A total of 162 cases treated with T-OLIF ( = 73) and AP-OLIF ( = 89) for degenerative lumbar disease were included. The mean operative time and blood loss were less with AP-OLIF ( < 0.01). Approach related complications were 14 (19.1%) with T-OLIF and 4 (4.5%) with AP-OLIF. Postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores improved in both T-OIF and AP-OIF groups ( < 0.01).

CONCLUSION

The modified OLIF technique (AP-OLIF) is characterized by an easy exposure of the lumbar spine under direct microscopic vision, resulting in less psoas weakness and neurovascular injury.

摘要

研究设计

这是一项回顾性研究。

目的

展示一种用于L1-L5的改良斜外侧腰椎椎间融合术（OILF）技术。

方法

改良技术通过劈开腰大肌腹的前部来进入腰大肌前下方的斜行通道（OC），最大限度减少对腰大肌的操作和牵拉，避免神经损伤，同时提供良好的显微镜视野。回顾性分析接受传统斜外侧腰椎椎间融合术（T-OLIF）或腰大肌前下斜外侧腰椎椎间融合术（AP-OLIF）治疗的患者的腰大肌无力和神经血管并发症发生率。还回顾了临床结果。

结果

共纳入162例因退行性腰椎疾病接受T-OLIF（n = 73）和AP-OLIF（n = 89）治疗的患者。AP-OLIF的平均手术时间和失血量更少（P < 0.01）。T-OLIF的手术入路相关并发症为14例（19.1%），AP-OLIF为4例（4.5%）。T-OIF组和AP-OIF组的术后视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分均有所改善（P < 0.01）。