Melbourne Orthopaedic Group, Melbourne, Australia.
Spine and Scoliosis Research Associates Australia, Melbourne, Australia.
Bone Joint J. 2024 Jan 1;106-B(1):53-61. doi: 10.1302/0301-620X.106B1.BJJ-2023-0693.R2.
The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique.
This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.
A total of 517 patients were included in the study. Their mean age was 65.0 years (SD 10.3) and their mean BMI was 29.2 kg/m (SD 5.5). A mean of 1.2 levels (SD 0.6) were fused with LLIF, and a mean of 1.6 (SD 0.9) posterior levels were fused. Femoral neuropraxia occurred in six patients (1.2%), of which four (0.8%) were LLIF-related and two (0.4%) had persistent symptoms one year postoperatively. Non-femoral neuropraxia occurred in nine patients (1.8%), one (0.2%) was LLIF-related and five (1.0%) were persistent at one year. All LLIF-related neuropraxias resolved by one year. A total of 32 patients (6.2%) had thigh pain, 31 (6.0%) were LLIF-related and three (0.6%) were persistent at one year. Weakness of hip flexion occurred in 14 patients (2.7%), of which eight (1.6%) were LLIF-related and three (0.6%) were persistent at one year. No patients had bowel injury, three (0.6%) had an intraoperative vascular injury (not LLIF-related), and five (1.0%) had ileus. Reoperations occurred in five patients (1.0%) within 30 days, 37 (7.2%) within 90 days, and 41 (7.9%) within one year postoperatively.
LLIF involving the L4-L5 disc level has a low rate of persistent neurological, psoas-related, and abdominal complications in patients with the appropriate indications and using a standardized surgical technique.
本研究旨在重新评估在使用标准化术前评估和手术技术进行 L4-L5 侧路腰椎体间融合术（LLIF）时与神经、腰大肌和腹部相关的并发症发生率。
这是一项多中心回顾性研究，纳入了在五年期间由七位外科医生在三个国家的七家机构中进行 L4-L5 LLIF 的连续患者。分析了患者的人口统计学细节和手术、再次手术和并发症的详细信息，包括股神经和非股神经损伤、大腿疼痛、髋关节屈曲无力和腹部并发症。记录术后一年时与 LLIF 或后路器械相关且持续存在的神经和腰大肌相关并发症。
共纳入 517 例患者。他们的平均年龄为 65.0 岁（标准差 10.3），平均 BMI 为 29.2kg/m（标准差 5.5）。平均融合 1.2 个节段（标准差 0.6），融合后路 1.6 个节段（标准差 0.9）。6 例患者（1.2%）出现股神经损伤，其中 4 例（0.8%）与 LLIF 相关，2 例（0.4%）术后一年仍有症状。9 例患者（1.8%）出现非股神经损伤，其中 1 例（0.2%）与 LLIF 相关，5 例（1.0%）术后一年仍有症状。所有与 LLIF 相关的神经损伤均在一年内得到解决。32 例患者（6.2%）出现大腿疼痛，其中 31 例（6.0%）与 LLIF 相关，3 例（0.6%）术后一年仍有症状。14 例患者（2.7%）出现髋关节屈曲无力，其中 8 例（1.6%）与 LLIF 相关，3 例（0.6%）术后一年仍有症状。无患者发生肠损伤，3 例（0.6%）术中发生血管损伤（与 LLIF 无关），5 例（1.0%）发生肠梗阻。5 例患者（1.0%）在术后 30 天内、37 例（7.2%）在术后 90 天内、41 例（7.9%）在术后 1 年内再次手术。
对于有适当适应证并使用标准化手术技术的患者，L4-L5 椎间盘水平的 LLIF 具有较低的持续神经、腰大肌和腹部并发症发生率。
