Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China.
BMC Musculoskelet Disord. 2023 Oct 23;24(1):836. doi: 10.1186/s12891-023-06974-x.
This is a retrospective study.
The aim of the study was to evaluate the efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF) in lumbar degenerative diseases.
Forty-eight patients with lumbar degenerative disease between January 2019 and June 2020 were enrolled in this study. All patients complained of low back and leg pain, which were aggravated during standing activities and alleviated or disappeared during lying. After general anesthesia, the patient was placed in the right decubitus position. The anterior edge of the psoas major muscle was exposed through an oblique incision of approximately 6 cm, using an extraperitoneal approach. The psoas major muscle was then properly retracted dorsally to expose the disc. After discectomy, a suitable cage filled with autogenous bone graft from the ilium was implanted. Two anchoring plates were inserted separately into the caudal and cranial vertebral bodies to lock the cage. Clinical efficacy was evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI). Lumbar lordosis, intervertebral disc height, spondylolisthesis rate, cage subsidence and fusion rate were also recorded.
A total of 48 patients were enrolled in this study, including 20 males and 28 females, aged 61.4 ± 7.3 (range 49-78) years old. Surgery was successfully performed in all patients. Lumbar stenosis and instability were observed in 22 cases, disc degenerative disease in eight cases, degenerative spondylolisthesis in nine cases, degenerative scoliosis in six cases, and postoperative revision in three cases. In addition, five patients were diagnosed with osteoporosis. The index levels included L2-3 in three patients, L3-4 in 13 patients, L4-5 in 23 patients, L2-4 in three patients, and L3-5 in six patients. The operation time was 81.1 ± 6.4 (range 65-102) min. Intraoperative blood loss was 39.9 ± 8.5 (range 15-72) mL. No severe complications occurred, such as nerve or blood vessel injuries. The patients were followed up for 11.7 ± 2.3 (range 4-18) months. At the last follow-up, the VAS decreased from 6.2 ± 2.3 to 1.7 ± 1.1, and the ODI decreased from 48.4% ± 11.2% to 10.9% ± 5.5%. Radiography showed satisfactory postoperative spine alignment. No cage displacement was found, but cage subsidence 2-3 mm was found in five patients without obvious symptoms, except transient low back pain in an obese patient. The lumbar lordosis recovered from 36.8° ± 7.9° to 47.7° ± 6.8°, and intervertebral disc height recovered from 8.2 ± 2.0 mm to 11.4 ± 2.5 mm. The spondylolisthesis rate decreased from 19.9% ± 4.9% to 9.4% ± 3.2%. The difference between preoperative and last follow-up was statistically significant (P<0.05).
SA-LLIF can provide immediate stability and good results for lumbar degenerative diseases with a standalone anchored cage without posterior internal fixation.
这是一项回顾性研究。
本研究旨在评估自锚定侧方腰椎椎间融合术（SA-LLIF）治疗腰椎退行性疾病的疗效。
2019 年 1 月至 2020 年 6 月，我们纳入了 48 例腰椎退行性疾病患者。所有患者均有腰痛和腿痛，站立活动时加重，卧位时缓解或消失。全身麻醉后，患者取右侧卧位。通过大约 6cm 的斜切口，采用腹膜外入路显露腰大肌前缘，将腰大肌适当向背部牵拉，显露椎间盘。切除椎间盘后，植入合适的充满髂骨自体骨移植物的椎间融合器。将两个锚固板分别插入头侧和尾侧椎体，以锁定椎间融合器。采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评估临床疗效。还记录了腰椎前凸角、椎间盘高度、滑脱率、椎间融合器下沉和融合率。
共纳入 48 例患者，男 20 例，女 28 例，年龄 61.4±7.3（49-78）岁。所有患者均成功完成手术。22 例患者存在腰椎狭窄和不稳定性，8 例存在椎间盘退行性疾病，9 例存在退行性滑脱，6 例存在退行性脊柱侧凸，3 例为术后翻修。此外，5 例患者被诊断为骨质疏松症。病变节段包括 L2-3 3 例，L3-4 13 例，L4-5 23 例，L2-4 3 例，L3-5 6 例。手术时间为 81.1±6.4（65-102）min，术中出血量为 39.9±8.5（15-72）mL。无神经或血管损伤等严重并发症发生。患者平均随访 11.7±2.3（4-18）个月。末次随访时，VAS 评分由 6.2±2.3 降至 1.7±1.1，ODI 由 48.4%±11.2%降至 10.9%±5.5%。影像学显示术后脊柱排列满意。未发现椎间融合器移位，但 5 例患者出现 2-3mm 的椎间融合器下沉，无明显症状，除 1 例肥胖患者出现一过性腰痛外。腰椎前凸角由 36.8°±7.9°恢复至 47.7°±6.8°，椎间盘高度由 8.2±2.0mm 恢复至 11.4±2.5mm。滑脱率由 19.9%±4.9%降至 9.4%±3.2%。术前与末次随访时比较，差异有统计学意义（P<0.05）。
自锚定侧方腰椎椎间融合术（SA-LLIF）可提供即刻稳定性，并为无后路内固定的孤立锚定融合器治疗腰椎退行性疾病提供良好的疗效。
