Singh Hardeep, Wellington Ian, Zeng Francine, Antonacci Christopher, Mancini Michael, Mohamed Mirghani, Broska Joellen, Mallozzi Scott, Moss Isaac
Department of Orthopedic Surgery, University of Connecticut Health Center, Comprehensive Spine Center, Farmington, CT, USA
Department of Orthopedic Surgery, University of Connecticut Health Center, Comprehensive Spine Center, Farmington, CT, USA.
Int J Spine Surg. 2024 Sep 12;18(4):400-407. doi: 10.14444/8625.
Lateral lumbar interbody fusion (LLIF) is commonly used to address various lumbar pathologies. LLIF using the prone transpsoas (PTP) approach has several potential advantages, allowing simultaneous access to the anterior and posterior columns of the spine. The aim of this study was to report the 1-year outcomes of LLIF via PTP.
This is a retrospective review of 97 consecutive patients who underwent LLIF via PTP. Radiographic parameters, including lumbar-lordosis, segmental-lordosis, anterior disc height, and posterior disc height, were measured on preoperative, initial-postoperative, and 1-year postoperative imaging. Patient-reported outcomes measures, including Oswestry Disability Index, visual analog scale (VAS), pain EQ5D, and postoperative complications, were reviewed.
Ninety-seven consecutive patients underwent 161 levels of LLIF. Fifty-seven percent underwent 1-level LLIF, 30% 2-level LLIF, 6% 3-level LLIF, and 7% 4-level LLIF. The most common level was L4 to L5 (35%), followed by L3 to L4 (33%), L2 to L3 (21%), and L1 to L2 (11%). Significant improvements were noted at initial and 1-year postoperative periods in lumbar-lordosis (2° ± 10°, = 0.049; 3° ± 9°, = 0.005), segmental-lordosis (6° ± 5°, < 0.001; 5° ± 5°, < 0.001), anterior disc height (8 mm ± 4 mm, < 0.001; 7 mm ± 4 mm, < 0.001), and posterior disc height (3 mm ± 2 mm, < 0.001; 3 mm ± 2 mm, < 0.001). Significant improvements were seen in Oswestry Disability Index at 6 weeks ( = 0.002), 6 months ( < 0.001), and 1 year ( < 0.001) postoperatively; pain EQ5D at 6 weeks ( < 0.001), 6 months ( < 0.001), and 1 year ( < 0.001) postoperatively; and leg and back visual analog scale at 2 weeks ( < 0.001), 6 months ( < 0.001), and 1 year ( < 0.001) postoperatively. The average length of stay was 2.5 days, and the most common complications were ipsilateral hip flexor pain (46%), weakness (59%), and contralateral hip flexor pain (29%).
PTP is a novel way of performing LLIF. These 1-year data support that PTP is an effective, safe, and viable approach with similar patient-reported outcome measures and complications profiles as LLIF performed in the lateral decubitus position.
腰椎外侧椎间融合术（LLIF）常用于治疗各种腰椎疾病。采用俯卧经腰大肌（PTP）入路的LLIF具有多种潜在优势，可同时显露脊柱的前柱和后柱。本研究旨在报告经PTP入路LLIF的1年疗效。
对97例连续接受经PTP入路LLIF的患者进行回顾性分析。在术前、术后即刻和术后1年的影像学检查中测量腰椎前凸、节段性前凸、椎间盘前缘高度和椎间盘后缘高度等影像学参数。回顾患者报告的结局指标，包括Oswestry功能障碍指数、视觉模拟量表（VAS）、疼痛EQ5D以及术后并发症。
97例连续患者共接受了161节段的LLIF。57%的患者接受1节段LLIF，30%接受2节段LLIF，6%接受3节段LLIF，7%接受4节段LLIF。最常见的节段是L4至L5（35%），其次是L3至L4（33%）、L2至L3（21%）和L1至L2（11%）。在术后即刻和术后1年时，腰椎前凸（分别为2°±10°，P = 0.049；3°±9°，P = 0.005）、节段性前凸（分别为6°±5°，P < 0.001；5°±5°，P < 0.001）、椎间盘前缘高度（分别为8 mm±4 mm，P < 0.001；7 mm±4 mm，P < 0.001）和椎间盘后缘高度（分别为3 mm±2 mm，P < 0.001；3 mm±2 mm，P < 0.001）均有显著改善。术后6周（P = 0.002）、6个月（P < 0.001）和1年（P < 0.001）时，Oswestry功能障碍指数有显著改善；术后6周（P < 0.001）、6个月（P < 0.001）和1年（P < 0.001）时，疼痛EQ5D有显著改善；术后2周（P < 0.001）、6个月（P < 0.001）和1年（P < 0.001）时，腿部和背部视觉模拟量表有显著改善。平均住院时间为2.5天，最常见的并发症是同侧髋屈肌疼痛（46%）、无力（59%）和对侧髋屈肌疼痛（29%）。
PTP是一种开展LLIF的新方法。这些1年的数据支持PTP是一种有效、安全且可行的方法，其患者报告的结局指标和并发症情况与侧卧位LLIF相似。
