Indirect Decompression Through Oblique Lateral Interbody Fusion for Revision Surgery After Lumbar Decompression
Indirect Decompression Through Oblique Lateral Interbody Fusion for Revision Surgery After Lumbar Decompression
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DOI：
10.1016/j.wneu.2020.05.151
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发表时间：
2020-09-01
影响因子：
2
通讯作者：
Matsuda, Shuichi
中科院分区：
文献类型：
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作者：
Shimizu, Takayoshi;Fujibayashi, Shunsuke;Matsuda, Shuichi
背景技术背景：尚未报告在与既往腰椎减压相同节段进行翻修手术的间接减压的临床结局。本研究的目的是探讨斜外侧椎间融合术（OLIF）在退行性腰椎疾病减压后翻修手术的疗效：我们纳入了34例术前诊断为椎管狭窄，椎间孔狭窄或椎间不稳定复发的患者，在同一水平的先前腰椎减压。这些患者接受了OLIF和补充椎弓根螺钉固定，没有额外的后路减压。所有患者均完成了至少1年的随访。我们比较了术前和最终随访时磁共振成像上的硬膜囊横截面积（CSA）以及临床结局评分（日本骨科协会[乔亚]评分）。结果：椎间隙从术前的136.4 ± 57.9 mm（2）扩大到最终随访时的194.1 ± 58.6 mm（2）（平均27.4个月; P < 0.001）。平均随访17.1个月，临床症状显著改善（乔亚评分改善率为59.0%）。融合率为93.0%。椎间盘高度恢复（术前：5.7 mm;术后：8.3 mm; P < 0.001），术后椎间孔狭窄明显改善。有没有重大的血管/输尿管injuries.Conclusions：OLIF在同一水平的一个先前的腰椎减压提供了一个成功的间接减压效果，包括扩张的硬膜囊，恢复椎间盘高度，并随后改善椎间孔狭窄。具体而言，该手术可以防止硬脊膜切开术和神经根损伤，这可能发生在传统的直接后路融合翻修手术中。
BACKGROUND: Clinical outcome of indirect decompression for a revision surgery, at the same level of a previous lumbar decompression, has not been reported. The purpose of this study was to investigate the efficacy of oblique lateral interbody fusion (OLIF) in revision surgery after decompression for degenerative lumbar spinal disease.METHODS: We included 34 patients who were preoperatively diagnosed with a recurrence of canal stenosis, foraminal stenosis, or intervertebral instability at the same level of a prior lumbar decompression. These patients underwent OLIF with supplemental pedicle screw fixation without additional posterior decompression. All patients completed a minimum 1-year follow-up. We compared the cross-sectional area (CSA) of the thecal sac on magnetic resonance imaging as well as clinical outcome scores (Japanese Orthopaedic Association [JOA] score) preoperatively and at the final follow- up. Fusion status and disc height/angle were evaluated based on computed tomography scans.RESULTS: The CSA expanded from 136.4 +/- 57.9 mm(2) preoperatively to 194.1 +/- 58.6 mm(2) at the final follow-up (mean: 27.4 months; P < 0.001). Clinical symptoms significantly improved (59.0% improvement rate of JOA score) at the average of a 17.1-month follow-up. The fusion rate was 93.0%. The disc height was restored (preoperative: 5.7 mm; postoperative: 8.3 mm; P < 0.001), and foraminal stenosis significantly improved postoperatively. There were no major vascular/ureteral injuries.CONCLUSIONS: OLIF at the same level of a prior lumbar decompression provided a successful indirect decompressive effect, including expansion of the thecal sac, restoration of disc height, and subsequent improvement of foraminal stenosis. Specifically, this procedure can prevent incidental durotomy and nerve root injury, which may occur in conventional revision surgeries for direct posterior fusion.