Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea.
PLoS One. 2023 Sep 14;18(9):e0291114. doi: 10.1371/journal.pone.0291114. eCollection 2023.
Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con.
We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space.
Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004).
Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location.
斜侧腰椎体间融合（OLIF）手术涉及在侧卧位中从前插入椎间笼。在 OLIF 之后，在俯卧位（OLIF-con）中进行椎弓根螺钉和棒系统的插入。笼的位置对于恢复腰椎前凸和间接减压很重要。然而，如果不进行滑脱复位，在理想位置插入笼是困难的，并且在插入椎间笼后复位可能会限制复位的程度。最近引入的脊柱导航系统使这两种手术都可以在一个侧卧位中进行（OLIF-one）。因此，可以在插入椎间笼之前进行滑脱复位。本研究的目的是比较 OLIF-one 和 OLIF-con 中滑脱复位和笼放置的情况。
我们回顾性分析了 72 例接受手术治疗的腰椎滑脱患者的临床资料；其中 30 例患者接受 OLIF-one 治疗，42 例患者接受 OLIF-con 治疗。OLIF-one 使用脊柱导航系统。在 OLIF-one 中，在减轻滑脱后插入椎间笼，而在 OLIF-con 中，在复位前插入笼。在 X 光片上测量以下参数：术前和术后滑脱滑移、复位程度和笼在椎间盘间隙中的位置。
两组患者的腰痛和腿痛均有显著改善（p＜0.05）。OLIF-con 后有 3 例患者出现短暂的运动或感觉改变，OLIF-one 后有 2 例患者出现这种改变。OLIF-one 组术前和术后的滑脱分别为 26.3±7.7%和 6.6±6.2%，OLIF-con 组分别为 23.1±7.0%和 7.4±5.8%。OLIF-one 组的滑脱复位率为 74.4±6.3%，OLIF-con 组为 65.4±5.7%，两组之间有显著差异（p=0.04）。OLIF-one 组笼的位置为 34.2±8.9%，OLIF-con 组为 42.8±10.3%，两组之间有显著差异（p=0.004）。
OLIF-one 手术中改变手术顺序，有利于滑脱复位和将笼置于理想位置。
