Antonacci Christopher L, Zeng Francine, Jackson Casey, Wellington Ian J, Patel Seema M, Esmende Sean M
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Orthopedic Associates of Hartford, Bone and Joint Institute, Hartford, CT, USA.
J Spine Surg. 2024 Jun 21;10(2):286-294. doi: 10.21037/jss-23-16. Epub 2024 May 14.
Adjacent segment disease (ASD) is a late complication of lumbar fusion characterized by persistent symptoms correlating to radiographic changes in the levels immediately above or below the prior fusion. Lateral interbody fusion (LIF) through a direct lateral approach is a minimally invasive and effective surgical treatment for ASD. Biomechanically, LIF for ASD provides significantly decreased motion in multiple planes. While hardware failure and injury to the lumbar plexus are potential complications, these risks may be outweighed by decreased blood loss, shorter operating room (OR) times, and possibly superior patient reported visual analog scale (VAS) scores compared to traditional posterior spinal fusion (PSF) alone. The purpose of this review is to summarize the history, uses, outcomes, and future directions of LIF for ASD.
A review of national databases (PubMed and SCOPUS) was performed using literature from 1900 to 2022. Keywords included terms "LATERAL" and "LUMBAR" and "INTERBODY" and "FUSION" and "ADJACENT" and "SEGMENT" and "DISEASE". Studies that aimed to describe the biomechanical, clinical course and complications, radiological outcomes, biomechanical aspects, need for revision surgery, and/or patient reported outcomes of the XLIF/LIF technique were included.
This review includes a brief overview of the natural history of ASD and current approaches to address it. It then summarizes the main indications and utilization of LIF to address ASD, summarizing reported outcomes in regard to biomechanical, clinical, and radiographic outcomes.
LIF has emerged as a minimally invasive and effective surgical treatment for ASD. This mini-review suggests that LIF provides a solid foundational biomechanical construct that has been paired with good patient-reported, clinical, and radiographic outcomes. While further research is required, current literature suggests that LIF for ASD results in fewer complications, decreased morbidity, and decreased need for subsequent surgery compared to other commonly utilized techniques.
相邻节段疾病（ASD）是腰椎融合术的一种晚期并发症，其特征为持续症状与先前融合节段上方或下方节段的影像学改变相关。经直接外侧入路的外侧椎间融合术（LIF）是治疗ASD的一种微创且有效的手术方法。从生物力学角度来看，用于治疗ASD的LIF可显著减少多个平面的活动度。虽然硬件故障和腰丛神经损伤是潜在并发症，但与单纯传统后路脊柱融合术（PSF）相比，LIF导致的失血量减少、手术时间缩短，患者报告的视觉模拟评分（VAS）可能更高，这些优势或许可抵消上述风险。本综述的目的是总结LIF治疗ASD的历史、用途、疗效及未来发展方向。
利用1900年至2022年的文献对国家数据库（PubMed和SCOPUS）进行综述。关键词包括“外侧”“腰椎”“椎间”“融合”“相邻”“节段”“疾病”。纳入旨在描述XLIF/LIF技术的生物力学、临床过程及并发症、放射学结果、生物力学方面、翻修手术需求和/或患者报告结果的研究。
本综述简要概述了ASD的自然病史及当前的治疗方法。然后总结了LIF治疗ASD的主要适应证和应用情况，概述了在生物力学、临床和放射学结果方面报告的疗效。
LIF已成为治疗ASD的一种微创且有效的手术方法。本小型综述表明，LIF提供了坚实的基础生物力学结构，并取得了良好的患者报告、临床和放射学结果。虽然仍需进一步研究，但当前文献表明，与其他常用技术相比，LIF治疗ASD导致的并发症更少、发病率更低，后续手术需求也更少。
