Instituto de Patologia da Coluna (IPC), São Paulo , Brazil.
University of Mississippi, Mississippi, USA.
Neurosurg Rev. 2024 Sep 4;47(1):529. doi: 10.1007/s10143-024-02740-2.
Lateral lumbar interbody fusion (LLIF), developed by Dr. Luiz Pimenta in 2006, allows access to the spinal column through the psoas major muscle. The technique has many advantages, such as reduced bone and muscular tissue damage, indirect decompression, larger implants, and lordosis correction capabilities. However, this technique also has drawbacks, with the most notorious being the risk of spinal pathologies due to indirect injury of the lumbar plexus, but with low rates of persistent injuries. Therefore, several groups have proposed classifications to help identify patients at a greater risk of presenting with neurological deficits. The present work proposes a classification system that relies on simple observation of easily identifiable key structures to guide lateral L4-L5 LLIF decision-making. Patients aged > 18 years who underwent preoperative magnetic resonance imaging (MRI) between 2022 and 2023 were included until 50 high-quality images were acquired. And excluded as follow Anatomical changes in the vertebral body or major psoas muscles prevent the identification of key structures or poor-quality MRIs. Each anatomy was classified as type I, type II, or type III according to the consensus among the three observers. Fifty anatomical sites were included in this study. 70% of the L4-L5 anatomy were type I, 18% were type II, and 12% were type III. None of the type 3 L4-L5 anatomies were approached using a lateral technique. The proposed classification is an easy and simple method for evaluating the feasibility of a lateral approach to-L4-L5.
侧方腰椎间融合术（LLIF）由 Luiz Pimenta 博士于 2006 年开发，通过腰大肌进入脊柱。该技术具有许多优点，例如减少骨和肌肉组织损伤、间接减压、更大的植入物和矫正脊柱前凸的能力。然而，该技术也有缺点，最明显的是由于对腰丛的间接损伤而导致脊柱病变的风险，但持续性损伤的发生率较低。因此，有几个小组提出了分类方法，以帮助识别更容易出现神经功能缺损的患者。本研究提出了一种分类系统，该系统依赖于对易于识别的关键结构的简单观察，以指导侧方 L4-L5 LLIF 的决策。纳入了 2022 年至 2023 年期间接受术前磁共振成像（MRI）的年龄大于 18 岁的患者，直到获得 50 张高质量图像。排除了以下情况：椎体或主要腰大肌的解剖结构变化会妨碍关键结构的识别或 MRI 质量差。根据三位观察者的共识，对每个解剖结构进行了 I 型、II 型或 III 型分类。这项研究共包括 50 个解剖部位。70%的 L4-L5 解剖结构为 I 型，18%为 II 型，12%为 III 型。没有一例 III 型 L4-L5 解剖结构采用侧方技术进行处理。所提出的分类是一种评估侧方入路到 L4-L5 的可行性的简单而简单的方法。
