Lv Hui, Yang Yu Sheng, Zhou Jian Hong, Guo Yuan, Chen Hui, Luo Fei, Xu Jian Zhong, Zhang Zhong Rong, Zhang Ze Hua
Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China.
Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, Chongqing, China.
Neurospine. 2023 Sep;20(3):824-834. doi: 10.14245/ns.2346378.189. Epub 2023 Sep 30.
To evaluate the clinical and radiological efficacy of a combine of lateral single screw-rod and unilateral percutaneous pedicle screw fixation (LSUP) for lateral lumbar interbody fusion (LLIF) in the treatment of spondylolisthesis.
Sixty-two consecutive patients with lumbar spondylolisthesis who underwent minimally invasive (MIS)-TLIF with bilateral pedicle screw (BPS) or LLIF-LSUP were retrospectively studied. Segmental lordosis angle (SLA), lumbar lordosis angle (LLA), disc height (DH), slipping percentage, the cross-sectional areas (CSA) of the thecal sac, screw placement accuracy, fusion rate and foraminal height (FH) were used to evaluate radiographic changes postoperatively. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy.
Patients who underwent LLIF-LSUP showed shorter operating time, less length of hospital stay and lower blood loss than MIS-TLIF. No statistical difference was found between the 2 groups in screw placement accuracy, overall complications, VAS, and ODI. Compared with MIS-TLIF-BPS, LLIF-LSUP had a significant improvement in sagittal parameters including DH, FH, LLA, and SLA. The CSA of MIS-TLIF-BPS was significantly increased than that of LLIF-LSUP. The fusion rate of LLIF-LSUP was significantly higher than that of MIS-TLIF-BPS at the follow-up of 3 months postoperatively, but there was no statistical difference between the 2 groups at the follow-up of 6 months, 9 months, and 12 months.
The overall clinical outcomes and complications of LLIF-LSUP were comparable to that of MIS-TLIF-BPS in this series. Compared with MIS-TLIF-BPS, LLIF-LSUP for lumbar spondylolisthesis represents a significantly shorter operating time, hospital stay and lower blood loss, and demonstrates better radiological outcomes to maintain lumbar lordosis, and reveal an overwhelming superiority in the early fusion rate.
评估外侧单螺杆-棒与单侧经皮椎弓根螺钉固定术（LSUP）联合用于腰椎椎间融合术（LLIF）治疗腰椎滑脱的临床及影像学疗效。
回顾性研究62例连续接受双侧椎弓根螺钉（BPS）微创经椎间孔腰椎椎体间融合术（MIS-TLIF）或LLIF-LSUP治疗的腰椎滑脱患者。采用节段性前凸角（SLA）、腰椎前凸角（LLA）、椎间盘高度（DH）、滑脱百分比、硬脊膜囊横截面积（CSA）、螺钉置入准确性、融合率及椎间孔高度（FH）评估术后影像学变化。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估临床疗效。
接受LLIF-LSUP的患者手术时间更短、住院时间更短且失血量更少，与MIS-TLIF相比。两组在螺钉置入准确性、总体并发症、VAS和ODI方面无统计学差异。与MIS-TLIF-BPS相比，LLIF-LSUP在矢状面参数（包括DH、FH、LLA和SLA）方面有显著改善。MIS-TLIF-BPS的CSA显著高于LLIF-LSUP。术后3个月随访时，LLIF-LSUP的融合率显著高于MIS-TLIF-BPS，但在术后6个月、9个月和12个月随访时，两组之间无统计学差异。
在本系列研究中，LLIF-LSUP的总体临床疗效和并发症与MIS-TLIF-BPS相当。与MIS-TLIF-BPS相比，LLIF-LSUP治疗腰椎滑脱的手术时间、住院时间显著更短，失血量更少，在维持腰椎前凸方面影像学结果更好，且在早期融合率方面显示出压倒性优势。
