Foong Bryan Chun Meng, Wong Joey Ying Hao, Betzler Brjan, Oh Jacob Yoong Leong
Department of Orthopedic Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore.
Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore, Singapore.
Int J Spine Surg. 2024 Nov 8;18(5):595-602. doi: 10.14444/8623.
Oblique lumbar interbody fusion (OLIF) through a prepsoas approach was identified as an alternative to alleviate complications associated with direct lateral interbody fusion. Cage placement is known to influence cage subsidence and fusion rates due to suboptimal biomechanics. There are limited studies exploring cage obliquity as a potential factor influencing fusion outcomes. Hence, our objective was to assess the effects of cage obliquity and position on fusion rates, subsidence, and sagittal alignment in patients who underwent OLIF.
Patients who underwent OLIF for levels L1 to L5 in our center, performed by a single surgeon and with a minimum of 12 months of follow-up, were included in the study. Cage obliquity and sagittal placement were measured, and their correlation with fusion, subsidence, and sagittal alignment correction was assessed. Fusion and subsidence were evaluated using the Bridwell Criteria and Marchi Criteria, respectively.
Among the included patients (age, 67.5 ± 7.93 years; 16 men and 37 women), 97 fusion levels were studied. The mean cage obliquity was 4.2° ± 2.8°. Ninety-six levels (99.0%) were considered to have achieved fusion with a Bridwell score of 1 or 2. Eighty-one (83.5%), 14 (14.4%), and 2 (2.06%) operated levels had a Marchi score of 0, 1, and 2, respectively. A Marchi grade of 1 or higher was considered indicative of significant subsidence. There was good improvement in both the segmental lordosis angle (4.2° ± 5.7°; < 0.0001) and disc height (4.5 ± 3.8 mm; < 0.0001). Cage placement did not have any statistical correlation with fusion rates, subsidence, or sagittal alignment.
Our results indicate that OLIF facilitates appropriate cage placement with only a minor degree of cage obliquity, typically less than 20°. This minor obliquity does not lead to lower fusion rates, increased subsidence, or sagittal malalignment. Despite subsidence being common, the majority of these cases resulted in complete fusion.
经腰大肌入路的斜外侧腰椎椎间融合术（OLIF）被视为一种可减轻与直接外侧椎间融合相关并发症的替代方法。由于生物力学欠佳，已知椎间融合器的放置会影响椎间融合器的下沉和融合率。关于椎间融合器倾斜度作为影响融合结果的潜在因素的研究有限。因此，我们的目的是评估椎间融合器倾斜度和位置对接受OLIF患者的融合率、下沉和矢状面排列的影响。
纳入在我们中心接受L1至L5节段OLIF手术、由单一外科医生操作且至少随访12个月的患者。测量椎间融合器的倾斜度和矢状面位置，并评估它们与融合、下沉和矢状面排列矫正的相关性。分别使用Bridwell标准和Marchi标准评估融合和下沉情况。
在纳入的患者中（年龄，67.5±7.93岁；男性16例，女性37例），共研究了97个融合节段。椎间融合器的平均倾斜度为4.2°±2.8°。99.0%（96个节段）被认为达到融合，Bridwell评分为1或2。分别有83.5%（81个节段）、14.4%（14个节段）和2.06%（2个节段）的手术节段Marchi评分为0、1和2。Marchi分级为1或更高被认为提示有明显下沉。节段性前凸角（4.2°±5.7°；P<0.0001）和椎间盘高度（4.5±3.8mm；P<0.0001）均有明显改善。椎间融合器的放置与融合率、下沉或矢状面排列无统计学相关性。
我们的结果表明，OLIF可实现椎间融合器的适当放置，椎间融合器倾斜度通常小于20°，仅为轻度倾斜。这种轻度倾斜不会导致融合率降低、下沉增加或矢状面排列不齐。尽管下沉很常见，但大多数病例实现了完全融合。
