PDF(Pubmed)
Abstract：
UNASSIGNED: Disadvantages of lateral interbody fusion (LIF) through a direct, transpsoas approach include difficulties associated with lateral decubitus positioning and limited sagittal correction without anterior longitudinal ligament release or posterior osteotomy. Prior technical descriptions advocate anchoring or docking the retractor into the posterior to middle aspect of the disc space.
UNASSIGNED: 72 patients who underwent 116 total levels of Prone Transpsoas (PTP) LIF with anterior docking with a single surgeon between December 2021 and May 2023 were included. Patient characteristics, perioperative data, as well as postoperative functional and radiographic outcomes were recorded. Subgroup analysis was performed for patients who underwent single-level PTP LIF with single-level percutaneous fixation (SLP). Patients in the SLP subgroup did not undergo direct decompression, release, or osteotomy.
UNASSIGNED: N=41 (56.9%) of cases included the L4-5 level. No vascular, bowel, or other visceral complications occurred. No patients developed a permanent motor deficit. Both the total cohort and the SLP group demonstrated statistically significant improvements in functional outcomes including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) as well as all radiographic parameters measured. Mean total operative time (incision to completion of closure for lateral and posterior fusion) in the SLP group was 104.3 minutes with a significant downward trend with increasing surgeon experience. The SLP group demonstrated a 9.9° increase in segmental lordosis (SL), a 7.5° increase in lumbar lordosis (LL), 5.3° reduction in pelvic tilt (PT), and a decrease in pelvic incidence - lumbar lordosis mismatch (PI-LL) from 11.0° preoperatively to 3.9°, postoperatively (p<.01).
UNASSIGNED: PTP LIF with anterior docking may address shortcomings associated with traditional lateral interbody fusion by producing safe and reproducible access with improved restoration of segmental lordosis and optimization of spinopelvic parameters.
UNASSIGNED: 72 patients who underwent 116 total levels of Prone Transpsoas (PTP) LIF with anterior docking with a single surgeon between December 2021 and May 2023 were included. Patient characteristics, perioperative data, as well as postoperative functional and radiographic outcomes were recorded. Subgroup analysis was performed for patients who underwent single-level PTP LIF with single-level percutaneous fixation (SLP). Patients in the SLP subgroup did not undergo direct decompression, release, or osteotomy.
UNASSIGNED: N=41 (56.9%) of cases included the L4-5 level. No vascular, bowel, or other visceral complications occurred. No patients developed a permanent motor deficit. Both the total cohort and the SLP group demonstrated statistically significant improvements in functional outcomes including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) as well as all radiographic parameters measured. Mean total operative time (incision to completion of closure for lateral and posterior fusion) in the SLP group was 104.3 minutes with a significant downward trend with increasing surgeon experience. The SLP group demonstrated a 9.9° increase in segmental lordosis (SL), a 7.5° increase in lumbar lordosis (LL), 5.3° reduction in pelvic tilt (PT), and a decrease in pelvic incidence - lumbar lordosis mismatch (PI-LL) from 11.0° preoperatively to 3.9°, postoperatively (p<.01).
UNASSIGNED: PTP LIF with anterior docking may address shortcomings associated with traditional lateral interbody fusion by producing safe and reproducible access with improved restoration of segmental lordosis and optimization of spinopelvic parameters.
摘要：
■通过直接，经肌入路包括与侧卧位定位相关的困难，以及在没有前纵韧带释放或后路截骨的情况下有限的矢状矫正。先前的技术描述主张将牵开器锚固或对接到椎间盘空间的后部到中部。
■72例患者在2021年12月至2023年5月期间与一名外科医生进行前对接，接受了116个总水平的俯卧透明肌（PTP）LIF。患者特征,围手术期数据,记录术后功能和影像学结局.对接受单级经皮固定（SLP）单级PTPLIF的患者进行亚组分析。SLP亚组患者未进行直接减压,释放,或者截骨术.
■N=41（56.9％）的病例包括L4-5水平。没有血管,肠,或其他内脏并发症发生。没有患者出现永久性运动缺陷。总队列和SLP组在功能结局方面均显示出统计学上的显着改善，包括Oswestry残疾指数（ODI）和视觉模拟量表（VAS）以及测量的所有影像学参数。SLP组的平均总手术时间（切口至完成闭合以进行外侧和后侧融合）为104.3分钟，随着外科医生经验的增加，显着下降趋势。SLP组显示节段前凸（SL）增加9.9°，腰椎前凸（LL）增加7.5°，骨盆倾斜减少5.3°(PT),骨盆发生率-腰椎前凸不匹配（PI-LL）从术前11.0°降低至3.9°，术后（p<0.01）。
■采用前路对接的PTPLIF可以通过产生安全和可重复的通路，改善节段前凸的恢复和脊柱骨盆参数的优化来解决与传统外侧椎间融合相关的缺点。
■72例患者在2021年12月至2023年5月期间与一名外科医生进行前对接，接受了116个总水平的俯卧透明肌（PTP）LIF。患者特征,围手术期数据,记录术后功能和影像学结局.对接受单级经皮固定（SLP）单级PTPLIF的患者进行亚组分析。SLP亚组患者未进行直接减压,释放,或者截骨术.
■N=41（56.9％）的病例包括L4-5水平。没有血管,肠,或其他内脏并发症发生。没有患者出现永久性运动缺陷。总队列和SLP组在功能结局方面均显示出统计学上的显着改善，包括Oswestry残疾指数（ODI）和视觉模拟量表（VAS）以及测量的所有影像学参数。SLP组的平均总手术时间（切口至完成闭合以进行外侧和后侧融合）为104.3分钟，随着外科医生经验的增加，显着下降趋势。SLP组显示节段前凸（SL）增加9.9°，腰椎前凸（LL）增加7.5°，骨盆倾斜减少5.3°(PT),骨盆发生率-腰椎前凸不匹配（PI-LL）从术前11.0°降低至3.9°，术后（p<0.01）。
■采用前路对接的PTPLIF可以通过产生安全和可重复的通路，改善节段前凸的恢复和脊柱骨盆参数的优化来解决与传统外侧椎间融合相关的缺点。
