Tomio Ryosuke
Department of Neurosurgery, Honjo Neurosurgery and Spine Surgery Clinic, Saitama 367-0030, Japan.
J Clin Med. 2025 Jun 26;14(13):4554. doi: 10.3390/jcm14134554.
: Lateral lumbar interbody fusion (LLIF) has gained popularity as an effective technique for indirect decompression through ligamentotaxis. Despite the perceived importance of using appropriately sized cages for achieving optimal decompression, comprehensive reports on cage size and its impact on indirect decompression are limited. This study aimed to assess the ligamentotaxis effect by measuring the "backward bulging" length in pre- and postoperative MRIs and examining its correlation with cage size and subsidence. : T2 images of 270 patients with lumbar herniated disc and/or lumbar spondylolisthesis (June 2022 to March 2025) were analyzed for 530 intervertebral spaces. Data on gender, age, length of hospital stay, preoperative and postoperative lumbar JOA scores, and the level of the disease were collected. Measurements included backward bulging length, intervertebral height, and cage subsidence. Statistical analysis was performed using StatMate. Surgical procedures involved oblique lateral interbody fusion (OLIF) to minimize impact on the iliopsoas and lumbar plexus. Trial cages starting from 8 mm were sequentially inserted, with confirmation through lateral fluoroscopy. Posterior fixation was performed using percutaneous pedicle screws. : Analysis of 530 intervertebral spaces revealed that 70% could accommodate a cage 3 mm or larger than the preoperative intervertebral height. Significant backward bulging shortening (3 mm or more) occurred in 339 spaces, predominantly with larger cages. Only 8.8% of cases (14/159) with a large backward bulging shortening had an intervertebral height extension of 3 mm or less. On the other hand, a large reduction in backward bulging was observed in 91.3% of cases (339/371) with an intervertebral height extension of 3 mm or more. Postoperative cage subsidence was observed in 9.2% (49/530) of all intervertebral spaces and 8.6% (32/371) in spaces where a cage larger than 3 mm was used. There was no statistically significant difference between these two groups. : To achieve a sufficient ligamentotaxis effect, it is necessary to select a cage size that allows for an intervertebral height increase of at least 3 mm compared to the preoperative measurement.
腰椎侧方椎间融合术（LLIF）作为一种通过韧带整复实现间接减压的有效技术，已越来越受欢迎。尽管人们认为使用尺寸合适的椎间融合器对于实现最佳减压很重要，但关于融合器尺寸及其对间接减压影响的全面报告却很有限。本研究旨在通过测量术前和术后MRI中的“后凸”长度，并检查其与融合器尺寸和下沉的相关性，来评估韧带整复效果。：对270例腰椎间盘突出症和/或腰椎滑脱患者（2022年6月至2025年3月）的530个椎间隙的T2图像进行分析。收集了性别、年龄、住院时间、术前和术后腰椎JOA评分以及疾病节段等数据。测量包括后凸长度、椎间隙高度和融合器下沉。使用StatMate进行统计分析。手术采用斜外侧椎间融合术（OLIF），以尽量减少对髂腰肌和腰丛的影响。从8mm开始依次插入试验性融合器，并通过侧位透视确认。使用经皮椎弓根螺钉进行后路固定。：对530个椎间隙的分析显示，70%的椎间隙能够容纳比术前椎间隙高度大3mm或更大的融合器。339个椎间隙出现了明显的后凸缩短（3mm或更多），主要是使用较大融合器的情况。在159例后凸明显缩短的病例中，只有8.8%（14/159）的椎间隙高度延长3mm或更少。另一方面，在椎间隙高度延长3mm或更多的病例中，91.3%（339/371）观察到后凸明显减小。在所有椎间隙中，9.2%（49/530）观察到术后融合器下沉，在使用大于3mm融合器的椎间隙中，8.6%（32/371）观察到下沉。这两组之间没有统计学上的显著差异。：为了获得足够的韧带整复效果，有必要选择一种与术前测量相比能使椎间隙高度增加至少3mm的融合器尺寸。
