Chung Hee-Woong, Lee Han-Dong, Lee Myungsub, Chung Nam-Su
Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Suwon 16499, Republic of Korea.
J Clin Med. 2025 May 10;14(10):3333. doi: 10.3390/jcm14103333.
Despite recent advances in minimally invasive extrapleural lateral approaches, oblique lateral interbody fusion (OLIF) at the upper lumbar level is often difficult and limited to optimal reconstruction. We aimed to compare the radiological outcomes and approach-related complications of OLIF between the upper (L1-2 or L2-3) and lower (L3-4 or L4-5) levels. This study is a retrospective review of OLIF in the upper (n = 63) and lower (n = 60) lumbar level groups. Radiological parameters included the anterior/posterior disc height, coronal/sagittal disc angle, cage position, cage subsidence, and fusion rate at a postoperative 1-year follow-up. Approach-related complications including pleural/peritoneal lacerations, neurovascular injury, and other organ injuries were examined. The baseline radiological parameters were similar between the two groups (all > 0.05). At 1-year postoperatively, the anterior disc height (ADH) was significantly greater in the lower-level group ( = 0.031), while no significant differences were observed in the posterior disc height, coronal/sagittal disc angle, cage anterior position, or cage subsidence rate (all > 0.05). The fusion rates were 97.9% and 95.0% at the upper and lower lumbar levels, respectively ( = 0.146). During OLIF at the upper lumbar level, chest tube insertion due to pleural laceration was observed in 11 (17.5%) cases. One case (1.2%) of segmental artery injury and two cases (3.2%) of pseudo-hernia were attributed to iliohypogastric nerve injury. Although the extrapleural approach in OLIF at the upper lumbar level is often limited, the radiological outcomes were comparable to those of OLIF at the lower lumbar level.
尽管最近微创胸膜外外侧入路取得了进展，但上腰椎水平的斜外侧椎间融合术（OLIF）通常操作困难，且仅限于最佳重建。我们旨在比较上腰椎（L1-2或L2-3）和下腰椎（L3-4或L4-5）水平OLIF的放射学结果及与手术入路相关的并发症。本研究是对上腰椎组（n = 63）和下腰椎组（n = 60）OLIF的回顾性研究。放射学参数包括术后1年随访时的前后椎间盘高度、冠状/矢状位椎间盘角度、椎间融合器位置、椎间融合器下沉及融合率。检查了与手术入路相关的并发症，包括胸膜/腹膜撕裂、神经血管损伤和其他器官损伤。两组的基线放射学参数相似（均P>0.05）。术后1年，下腰椎组的前椎间盘高度（ADH）显著更高（P = 0.031），而后椎间盘高度、冠状/矢状位椎间盘角度、椎间融合器前位或椎间融合器下沉率均无显著差异（均P>0.05）。上、下腰椎水平的融合率分别为97.9%和95.0%（P = 0.146）。在上腰椎水平OLIF期间，11例（17.5%）出现因胸膜撕裂而插入胸管的情况。1例（1.2%）节段动脉损伤和2例（3.2%）假性疝归因于髂腹下神经损伤。尽管上腰椎水平OLIF的胸膜外入路通常受限，但其放射学结果与下腰椎水平OLIF相当。
