Department of Orthopaedics, The Second Hospital, Shanxi Medical University, Taiyuan Shanxi Province, China.
The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Orthop Surg. 2024 Nov;16(11):2633-2643. doi: 10.1111/os.14151. Epub 2024 Jul 30.
As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure.
A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results.
Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints.
Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.
随着人口老龄化和技术进步，侧向腰椎椎间融合术（LLIF）在退行性腰椎侧凸（DLS）的治疗中越来越受欢迎。本研究通过观察和评估手术前后的临床疗效、影像学变化和并发症，探讨了 LLIF 治疗 DLS 的可行性、微创理念和益处。
回顾性分析了 2019 年 1 月至 2023 年 1 月间接受 LLIF 的 52 例 DLS 患者（12 名男性，40 名女性；年龄 65.84±9.873 岁）的临床资料。记录手术时间、出血量、并发症，以及临床疗效指标（视觉模拟评分[VAS]、Oswestry 功能障碍指数[ODI]和 36 项简明健康状况调查问卷[SF-36]）和影像学指标（冠状位：Cobb 角和正中骶骨垂线-C7 铅垂线[CSVL-C7PL]；矢状位：矢状垂直轴[SVA]、腰椎前凸角[LL]、骨盆入射角[PI]和胸椎后凸角[TK]）。所有患者均获得随访。比较患者术后和末次随访时上述临床评估指标和影像学结果与术前结果。
与术前相比，术后 Cobb 角和 LL 角明显改善（p<0.001）。同时，CSVL-C7PL、SVA 和 TK 术后变化不大（p>0.05），但随访时明显改善（p<0.001）。PI 术后及随访时均无明显变化。手术时间为 283.90±81.62min，总出血量为 257.27±213.44mL。无明显并发症发生。患者平均随访 21.7±9.8 个月。术后和末次随访时 VAS、ODI 和 SF-36 评分均明显优于术前（p<0.001）。与术前相比，术后 Cobb 角和 LL 角明显改善（p<0.001）。CSVL-C7PL、SVA 和 TK 术后稳定（p>0.05），但随访时明显改善（p<0.001）。PI 术后及随访时均无明显变化。
侧向腰椎椎间融合术治疗 DLS 可显著改善腰椎矢状和冠状平衡，以及代偿性胸椎侧凸，临床和影像学效果良好。此外，手术出血量少、创伤小、恢复快。
