Abstract：
OBJECTIVE: As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure.
METHODS: A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results.
RESULTS: Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints.
CONCLUSIONS: Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.
METHODS: A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results.
RESULTS: Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints.
CONCLUSIONS: Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.
摘要：
目标：随着人口老龄化和技术进步，腰椎外侧椎间融合术（LLIF）在治疗退变性腰椎侧凸（DLS）方面越来越受欢迎。这项研究调查了可行性，微创概念，通过观察和评估临床疗效，以及LLIF治疗DLS的益处，成像变化,以及手术后的并发症。
方法：对52例DLS患者（男性12例，女性40例，年龄65.84±9.873岁），从2019年1月至2023年1月接受LLIF。操作时间,失血,并发症,临床疗效指标(视觉模拟评分[VAS]，Oswestry残疾指数[ODI]，和36项简表调查)，和成像指标（冠状位置：Cobb角和中心骶骨垂直线-C7铅垂线[CSVL-C7PL]；矢状位置：矢状垂直轴[SVA]，腰椎前凸[LL]，骨盆入射角[PI],测量胸椎后凸角度[TK])。所有患者均获得随访。将患者术后及末次随访的上述临床评价指标和影像学结果与术前结果进行比较。
结果：与术前值相比，术后Cobb角和LL角均有明显改善(p<0.001)。同时,CSVL-C7PL,SVA,术后TK变化不大（p>0.05），但随访时显着改善（p<0.001）。在术后或随访时间点，PI均无明显变化。手术时间为283.90±81.62min，总失血量为257.27±213.44mL。无明显并发症发生。随访21.7±9.8个月。VAS,ODI,和SF-36评分在术后和最终随访与术前水平相比显著改善(p<0.001)。手术后,与术前值相比,Cobb角和LL角有显著改善(p<0.001).CSVL-C7PL,SVA,术后TK稳定（p>0.05），但随访期间明显改善（p<0.001）。PI在术后或随访时间点都没有显着变化。
结论：侧位腰椎椎间融合治疗DLS能明显改善腰椎矢状位和冠状位平衡，以及代偿性胸椎侧凸，具有良好的临床和放射学发现。此外，血少了,更少的创伤，从手术中更快地恢复。
方法：对52例DLS患者（男性12例，女性40例，年龄65.84±9.873岁），从2019年1月至2023年1月接受LLIF。操作时间,失血,并发症,临床疗效指标(视觉模拟评分[VAS]，Oswestry残疾指数[ODI]，和36项简表调查)，和成像指标（冠状位置：Cobb角和中心骶骨垂直线-C7铅垂线[CSVL-C7PL]；矢状位置：矢状垂直轴[SVA]，腰椎前凸[LL]，骨盆入射角[PI],测量胸椎后凸角度[TK])。所有患者均获得随访。将患者术后及末次随访的上述临床评价指标和影像学结果与术前结果进行比较。
结果：与术前值相比，术后Cobb角和LL角均有明显改善(p<0.001)。同时,CSVL-C7PL,SVA,术后TK变化不大（p>0.05），但随访时显着改善（p<0.001）。在术后或随访时间点，PI均无明显变化。手术时间为283.90±81.62min，总失血量为257.27±213.44mL。无明显并发症发生。随访21.7±9.8个月。VAS,ODI,和SF-36评分在术后和最终随访与术前水平相比显著改善(p<0.001)。手术后,与术前值相比,Cobb角和LL角有显著改善(p<0.001).CSVL-C7PL,SVA,术后TK稳定（p>0.05），但随访期间明显改善（p<0.001）。PI在术后或随访时间点都没有显着变化。
结论：侧位腰椎椎间融合治疗DLS能明显改善腰椎矢状位和冠状位平衡，以及代偿性胸椎侧凸，具有良好的临床和放射学发现。此外，血少了,更少的创伤，从手术中更快地恢复。
