Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
Smt. SCL General Hospital, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India.
Eur Spine J. 2023 Aug;32(8):2776-2795. doi: 10.1007/s00586-023-07700-w. Epub 2023 Apr 17.
The retrospective study aimed to report the surgical technique and clinic-radiological outcomes of endoscopic anterior to psoas interbody lumbar fusion through the retroperitoneal approach with direct and indirect decompression.
We retrospectively analyzed the results of clinical parameters of patients who underwent endoscopic anterior to psoas interbody lumbar fusion between June 2013 and June 2022. Clinical outcomes were evaluated by the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The radiological outcomes were measured and statistically compared in disc height index (DHI), whole lumbar lordosis (WLL), pelvic Incidence (PI), pelvic tilt (PT), Segmental lordosis (SL), the sagittal vertical axis (SVA).
A total of 35 patients were selected for the procedure ranging in age from 51 to 84 years with 17.83 ± 8.85 months follow-up. The mean operation time in lateral position for one level was 162.96 ± 35.76 min (n = 24), and 207.73 ± 66.60 min for two-level fusion. The mean endoscopic time was 32.83 ± 17.71 min per level, with a total estimated blood loss of 230.57 ± 187.22 cc. The mean postoperative VAS back, leg pain score and ODI improved significantly compared to the preoperative values; Radiological data showed significant change in WLL, SL, DHI, PI, PT, and SS; however, there is no significant difference in SVA postoperatively. Subgroup analysis for the radiographic data showed 50 mm length cage has significantly improved for the DHI, SS and SVA compare to 40 mm length cage. The subgroup analysis results showed that hypertensive patients had significantly higher proportion in the incomplete fusion group compare to complete fusion group at one-year follow-up.
The endoscopic anterior to psoas interbody lumbar fusion achieves satisfactory indirect and direct decompression. This convergent technique presents an effective choice for treating lumbar instability associated with disc herniations and foraminal stenosis, thus complementing the indications for oblique lumbar interbody fusion.
本回顾性研究旨在报告经腹膜后入路行内镜下腰大肌前方椎间融合术（通过直接和间接减压）的手术技术和临床影像学结果。
我们回顾性分析了 2013 年 6 月至 2022 年 6 月期间接受内镜下腰大肌前方椎间融合术的患者的临床参数结果。通过视觉模拟评分（VAS）和 Oswestry 残疾指数（ODI）评分评估临床结果。通过测量并统计比较椎间盘高度指数（DHI）、全腰椎前凸（WLL）、骨盆入射角（PI）、骨盆倾斜角（PT）、节段前凸（SL）、矢状垂直轴（SVA）来评估影像学结果。
共选择 35 例年龄 51 至 84 岁的患者进行该手术，平均随访 17.83±8.85 个月。单节段融合时，侧卧位的平均手术时间为 162.96±35.76 分钟（n=24），双节段融合时为 207.73±66.60 分钟。每节段的平均内镜时间为 32.83±17.71 分钟，总估计失血量为 230.57±187.22cc。与术前相比，术后 VAS 背部、腿部疼痛评分和 ODI 显著改善；影像学数据显示 WLL、SL、DHI、PI、PT 和 SS 有显著变化；然而，术后 SVA 无显著差异。影像学数据的亚组分析显示，50mm 长度的椎间融合器在 DHI、SS 和 SVA 方面的改善明显优于 40mm 长度的椎间融合器。亚组分析结果显示，高血压患者在术后 1 年随访时，不完全融合组的比例明显高于完全融合组。
内镜下腰大肌前方椎间融合术可实现满意的间接和直接减压。这种融合技术为治疗与椎间盘突出和神经孔狭窄相关的腰椎不稳定提供了有效的选择，从而补充了斜向腰椎体间融合术的适应证。
