Lee Young-Seok, Ko Myeong Jin, Park Seung Won
Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
Neurospine. 2025 Mar;22(1):222-230. doi: 10.14245/ns.2449070.535. Epub 2025 Mar 31.
Postoperative ileus (POI) typically occurs after abdominal surgery but can also affect patients undergoing spinal surgery via the lateral retroperitoneal approach, such as oblique lumbar interbody fusion (OLIF). Therefore, this study aimed to investigate the incidence and risk factors associated with POI in OLIF.
This retrospective study examined a cohort of 465 patients who underwent OLIF from 2015 to 2023. Patient demographics, comorbidities, pre- and postoperative laboratory test results, and perioperative status were assessed. General condition of patients was assessed using the modified frailty index-11 (mFI-11), prognostic nutrition index, and geriatric nutrition risk index. In OLIF, the size and location of the psoas muscle involved in retraction and its relationship with the vertebral body were also investigated.
POI occurred in 19 patients (4%). Lower mFI-11 was linked to a higher risk of POI. While psoas muscle size had no significant effect on the risk of POI, the anterior location of the psoas muscle relative to the vertebral body was associated with a higher occurrence of POI. Multivariate logistic regression analysis of POI identified mFI-11 as the most significant risk factor (p = 0.003).
This study demonstrated that frailty and nutritional status can influence the occurrence of POI after OLIF. Additionally, bowel manipulation associated with the location of psoas muscle and vertebral body was identified as a risk factor. Proper assessment and improvement in patient frailty and nutritional status before surgery can help predict and prevent the occurrence of postoperative POI.
术后肠梗阻（POI）通常发生于腹部手术后，但也可影响经外侧腹膜后入路进行脊柱手术的患者，如斜外侧腰椎椎间融合术（OLIF）。因此，本研究旨在调查OLIF中POI的发生率及相关危险因素。
本回顾性研究纳入了2015年至2023年期间接受OLIF手术的465例患者。评估患者的人口统计学资料、合并症、术前和术后实验室检查结果以及围手术期状况。采用改良衰弱指数-11（mFI-11）、预后营养指数和老年营养风险指数评估患者的一般状况。在OLIF手术中，还研究了牵开所涉及的腰大肌的大小和位置及其与椎体的关系。
19例患者（4%）发生了POI。较低的mFI-11与POI的较高风险相关。虽然腰大肌大小对POI风险无显著影响，但腰大肌相对于椎体的前方位置与POI的较高发生率相关。对POI进行多因素逻辑回归分析发现，mFI-11是最显著的危险因素（p = 0.003）。
本研究表明，衰弱和营养状况可影响OLIF术后POI的发生。此外，与腰大肌和椎体位置相关的肠道操作被确定为一个危险因素。术前对患者衰弱和营养状况进行适当评估并加以改善，有助于预测和预防术后POI的发生。
