Rohde Matthew, Echevarria Alexandra, Carrier Robert, Zinner Matthew, Ngan Alex, Verma Rohit
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Northwell Health Department of Orthopedic Surgery, NorthShore University Hospital, Manhasset, NY, USA.
Int J Spine Surg. 2024 Sep 12;18(4):408-417. doi: 10.14444/8626.
Lateral lumbar interbody fusion (LLIF) with posterior screw fusion is a safe and effective treatment for patients suffering from degenerative spine disorders. While LLIF has been shown to restore disc height, decompress neural components, correct sagittal imbalances, and improve pain scores, the approach requires repositioning patients for posterior pedicle fixation, which requires 2 separate surgeries. The evolution of surgical techniques, navigation, and robotics has allowed for a single position approach to LLIF with the patient in the prone position. The purpose of this study was to perform a systematic review and meta-analysis comparing the prone single position (PSP) LLIF approach to the dual position LLIF approach. We hypothesized that PSP LLIF will have a reduced operative time, complication rate, and blood loss compared with the dual position LLIF procedure.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and Embase databases were searched with key terms: (lateral AND [interbody OR "inter body"] AND lumbar AND fusion) AND (prone OR single). Results were extracted and reviewed by 2 authors (MR and RB) per selection criteria. Patient demographics were extracted from the selected studies, along with surgical, patient-reported, and radiographic outcomes. A meta-analysis was performed using an unstandardized mean difference or log odds ratio with a confidence level of 95%.
Fifteen studies were included in the systematic review and 5 studies compared PSP LLIF to dual position LLIF for meta-analysis. PSP LLIF had a reduced operative time and length of stay compared with the dual position approach, although there was no significant reduction in estimated blood loss. Additionally, PSP LLIF improved lumbar lordosis more effectively than dual position LLIF. There was no difference in segmental lordosis or pelvic tilt. There was no difference in intraoperative complications, postoperative complications, or reoperations.
PSP LLIF reduces operative time and length of stay, with no relative increase in complications or reoperations compared with the dual position approach. Additionally, PSP LLIF improves lumbar lordosis relative to dual position LLIF, which may improve functional outcomes and reduce the risk of developing adjacent segment disease.
The associated operative and postoperative benefits of PSP LLIF may improve long-term outcomes of patients undergoing spinal fusion.
后路螺钉融合的外侧腰椎椎间融合术（LLIF）是治疗退行性脊柱疾病患者的一种安全有效的方法。虽然LLIF已被证明能恢复椎间盘高度、减压神经结构、纠正矢状面失衡并改善疼痛评分，但该方法需要重新摆放患者体位以进行后路椎弓根固定，这需要进行两次单独的手术。手术技术、导航和机器人技术的发展使得可以采用单一俯卧位进行LLIF手术。本研究的目的是进行一项系统评价和荟萃分析，比较俯卧位单切口（PSP）LLIF手术与双切口LLIF手术。我们假设与双切口LLIF手术相比，PSP LLIF手术的手术时间、并发症发生率和失血量会减少。
根据《系统评价和荟萃分析的首选报告项目2020》指南进行系统评价。在PubMed和Embase数据库中检索关键词：（外侧 AND [椎间融合 OR “椎间融合术”] AND 腰椎 AND 融合）AND（俯卧位 OR 单切口）。根据入选标准，由两位作者（MR和RB）提取并审查结果。从所选研究中提取患者人口统计学数据以及手术、患者报告和影像学结果。使用非标准化均数差或对数比值比进行荟萃分析，置信水平为95%。
15项研究纳入系统评价，5项研究比较了PSP LLIF和双切口LLIF进行荟萃分析。与双切口手术相比，PSP LLIF手术的手术时间和住院时间缩短，尽管估计失血量没有显著减少。此外，PSP LLIF比双切口LLIF更有效地改善腰椎前凸。节段性前凸或骨盆倾斜没有差异。术中并发症、术后并发症或再次手术没有差异。
与双切口手术相比，PSP LLIF缩短了手术时间和住院时间，并发症或再次手术没有相对增加。此外，与双切口LLIF相比，PSP LLIF改善了腰椎前凸，这可能改善功能结局并降低相邻节段疾病的发生风险。
PSP LLIF相关的手术和术后益处可能改善接受脊柱融合术患者的长期结局。
