Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity Clinical and Radiological Efficacy With Minimum Two Years Follow-up
Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity Clinical and Radiological Efficacy With Minimum Two Years Follow-up
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DOI：
10.1097/brs.0000000000002507
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发表时间：
2018-07-15
期刊：
影响因子：
3
通讯作者：
Kim, Jong-Bin
中科院分区：
文献类型：
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作者：
Park, Hyung-Youl;Ha, Kee-Yong;Kim, Jong-Bin
研究设计。一项回溯性队列研究。目的：评价微创外侧腰椎间融合术(LLIF)联合后路开放椎体融合术(PSF)治疗成人脊柱畸形(ASD)的临床和放射学疗效。微创技术已越来越多地应用于ASD的外科治疗。很少有报道直接比较LLIF联合PSF和传统PSF治疗ASD的疗效。为评价微创LLIF治疗ASD的优势，将微创LLIF+开放PSF组(联合组)与单纯PSF组(单纯PSF组)进行比较。评估畸形矫正和间接减压术的临床和放射学结果。对近端连接后凸(PJK)和近端连接失败(PJF)的发生情况也进行了评估。两组间在OSwestry功能障碍指数(ODI)、视觉模拟评分和包括再手术在内的主要并发症方面的临床结果没有显著差异。冠状畸形矫正无明显优势，但联合组术后腰椎前凸恢复(15.3°vs.8.87°，P=0.003)和最后一次随访(6.69°vs.1.02°，P=0.029)均显著高于单纯PSF组。在间接减压的亚组分析中，联合组的椎管面积(104 mm比122 mm(2))和孔高度(16.2 mm比18.5 mm)显著增加。联合组PJK或PJF的发生率明显高于单纯PSF组(P=0.039)。与单纯后路手术相比，LLIF具有间接减压、矢状面矫正效果更好等优点。LLF的实施应考虑上述优点和并发症，包括ASD的PJK或PJF。
Study Design. A retrospective cohort study.Objective. To evaluate the clinical and radiological efficacies of supplementing minimally invasive lateral lumbar interbody fusion (LLIF) with open posterior spinal fusion (PSF) in adult spinal deformity (ASD).Summary of Background Data. Minimally invasive techniques have been increasingly applied for surgery of ASD. Few reports have been published that directly compare LLIF combined with PSF to conventional PSF for ASD.Methods. To evaluate the advantages of minimally invasive LLIF for ASD, patients who underwent minimally invasive LLIF followed by open PSF (combined group) were compared with patients who only underwent PSF (only PSF group). The clinical and radiological outcomes for deformity correction and indirect decompression were assessed. The occurrence of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) were also evaluated.Results. No significant differences were observed in the clinical outcomes of the Oswestry Disability Index (ODI), visual analog scale, and major complications including reoperations between the groups. No additional advantage was found for coronal deformity correction, but the restoration of lumbar lordosis in the combined group was significantly higher postoperatively (15.3 degrees vs. 8.87 degrees, P = 0.003) and last follow-up (6.69 degrees vs. 1.02 degrees, P = 0.029) compared to that of the only PSF group. In the subgroup analysis for indirect decompression for the combined group, a significant increase of canal area (104 vs. 122mm(2)) and foraminal height (16.2 vs. 18.5mm) was noted. The occurrence of PJK or PJF was significantly higher in the combined group than in the only PSF group (P = 0.039).Conclusion. LLIF has advantages of indirect decompression and greater improvements of sagittal correction compared to only posterior surgery. LLIF should be conducted considering the above-mentioned benefits and complications including PJK or PJF in ASD.