Shimizu Takayoshi, Otsuki Bungo, Masuda Soichiro, Sono Takashi, Murata Koichi, Matsuda Shuichi
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Eur Spine J. 2025 May;34(5):1995-2001. doi: 10.1007/s00586-025-08719-x. Epub 2025 Feb 14.
To investigate the factors affecting indirect dural sac expansion on MRI in single-level Lateral Lumbar Interbody Fusion (LLIF) for degenerative lumbar spondylolisthesis. The focus was on identifying preoperatively selectable and intraoperatively modifiable factors that contribute to or detract from successful indirect decompression, as evidenced by dural sac expansion.
A retrospective review of 88 consecutive patients who underwent single-level LLIF surgery for degenerative lumbar spondylolisthesis at a single academic institute from January 2013 to December 2022 was conducted. Parameters measured included preoperative and postoperative slip distance, disc height (DH), cage position, and the canal cross-sectional area (CSA) of the dural sac using MRI. Multivariable regression analysis was conducted to identify factors affecting the change in CSA and segmental disc angle (SDA).
The study included patients with an average age of 68.1, primarily undergoing L4-5 LLIF. Significant improvements were noted postoperatively in CSA and disc heights. Multivariable regression showed that smaller preoperative posterior DH and more posterior cage positions significantly increased CSA, whereas smaller anterior DH and more anterior cage positions increased SDA. There was no significant correlation between the change in slip distance and CSA.
Factors contributing to indirect decompression following LLIF for lumbar degenerative spondylolisthesis are primarily associated with an increase in posterior intervertebral height. However, an excessive increase due to posterior placement of the interbody cage may negatively impact the local lordotic angle. The study also suggests that a focus on slip correction may not significantly influence the efficacy of indirect decompression.
探讨影响单节段腰椎外侧椎间融合术（LLIF）治疗退变性腰椎滑脱症时硬膜囊间接扩张的因素。重点是确定术前可选择和术中可调整的因素，这些因素有助于或不利于成功的间接减压，硬膜囊扩张可证明这一点。
对2013年1月至2022年12月在单一学术机构接受单节段LLIF手术治疗退变性腰椎滑脱症的88例连续患者进行回顾性研究。测量的参数包括术前和术后的滑脱距离、椎间盘高度（DH）、椎间融合器位置以及使用MRI测量的硬膜囊椎管横截面积（CSA）。进行多变量回归分析以确定影响CSA和节段椎间盘角度（SDA）变化的因素。
该研究纳入的患者平均年龄为68.1岁，主要接受L4-5节段的LLIF手术。术后CSA和椎间盘高度有显著改善。多变量回归显示，术前较小的后DH和更靠后的椎间融合器位置显著增加CSA，而较小的前DH和更靠前的椎间融合器位置增加SDA。滑脱距离的变化与CSA之间无显著相关性。
LLIF治疗腰椎退变性滑脱症后间接减压的因素主要与椎间后高度增加有关。然而，椎间融合器后位放置导致的过度增加可能会对局部前凸角产生负面影响。该研究还表明，专注于滑脱矫正可能不会显著影响间接减压的效果。
