Abstract：
BACKGROUND: Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disc space by passing through a retroperitoneal corridor either pre- or trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach. However, there is a paucity of evidence on the prevalence of surgical complications following lateral fusion surgery in patients with a history of abdominal surgery.
OBJECTIVE: The primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical.
METHODS: Retrospective study.
METHODS: Patients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study.
METHODS: The primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration.
METHODS: The electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria).
RESULTS: Of 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02-2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20-1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p>.05).
CONCLUSIONS: Though retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.
OBJECTIVE: The primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical.
METHODS: Retrospective study.
METHODS: Patients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study.
METHODS: The primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration.
METHODS: The electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria).
RESULTS: Of 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02-2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20-1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p>.05).
CONCLUSIONS: Though retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.
摘要：
背景：腰椎椎间融合术（LIF）的侧向入路允许通过腹膜后通道前肌或经腰肌进入腰椎和椎间盘间隙。这种方法的禁忌症是存在腹膜后瘢痕，这可能是由于先前在腹膜后空间进行手术干预或具有纤维化变化的炎症条件而发生的，并且对这种方法所需的动员和可视化构成挑战。然而,在有腹部手术史的患者中，缺乏关于外侧融合手术后手术并发症发生率的证据。
目的：本研究的主要目的是描述外侧椎间融合术后的手术并发症与之前的腹部手术之间的关联。
方法：回顾性研究。
方法：18岁以上接受腰椎外侧融合术的患者，2011年至2019年的三级护理中心纳入研究.
方法：主要结果包括医学，外科,术中或术后90天的大腿相关并发症。其他结果指标包括再入院率，逗留时间,和手术持续时间。
方法：对250名患者的电子健康记录进行了人口统计信息审查，手术数据,并发症,手术后再入院。使用多变量逻辑回归分析患者和手术因素与并发症发生率的关系。采用R统计软件(R,维也纳,奥地利)。
结果：在250例外侧椎间融合患者中，62.8%有腹部手术史，13.8%有结肠疾病史。围手术期最常见的并发症是短暂性大腿或腹股沟疼痛/感觉改变（n=62，24.8%）。考虑到腹部手术前的多变量逻辑回归，年龄,BMI,结肠疾病史，多层次手术,与腰大肌相关的方法发现,手术并发症发生率与结肠疾病(OR0.40,95%CI0.02-2.22)或既往腹部手术史(OR0.56,95%CI0.20-1.55)之间无显著关联.Further,先前腹部手术的侵袭性与整体脊柱并发症发生率无关，外侧特异性并发症,或再入院率（p>0.05）。
结论：尽管腹膜后瘢痕形成是腰椎侧入路的重要考虑因素，这项研究发现腰椎侧入路并发症发生率与腹部手术前无关联.需要进一步的研究来确定炎症性结肠疾病对脊柱外侧入路手术的影响。
目的：本研究的主要目的是描述外侧椎间融合术后的手术并发症与之前的腹部手术之间的关联。
方法：回顾性研究。
方法：18岁以上接受腰椎外侧融合术的患者，2011年至2019年的三级护理中心纳入研究.
方法：主要结果包括医学，外科,术中或术后90天的大腿相关并发症。其他结果指标包括再入院率，逗留时间,和手术持续时间。
方法：对250名患者的电子健康记录进行了人口统计信息审查，手术数据,并发症,手术后再入院。使用多变量逻辑回归分析患者和手术因素与并发症发生率的关系。采用R统计软件(R,维也纳,奥地利)。
结果：在250例外侧椎间融合患者中，62.8%有腹部手术史，13.8%有结肠疾病史。围手术期最常见的并发症是短暂性大腿或腹股沟疼痛/感觉改变（n=62，24.8%）。考虑到腹部手术前的多变量逻辑回归，年龄,BMI,结肠疾病史，多层次手术,与腰大肌相关的方法发现,手术并发症发生率与结肠疾病(OR0.40,95%CI0.02-2.22)或既往腹部手术史(OR0.56,95%CI0.20-1.55)之间无显著关联.Further,先前腹部手术的侵袭性与整体脊柱并发症发生率无关，外侧特异性并发症,或再入院率（p>0.05）。
结论：尽管腹膜后瘢痕形成是腰椎侧入路的重要考虑因素，这项研究发现腰椎侧入路并发症发生率与腹部手术前无关联.需要进一步的研究来确定炎症性结肠疾病对脊柱外侧入路手术的影响。
