目的:俯卧跨肌入路是传统外侧腰椎椎间融合术(LLIF)的单位置替代方法。早期倾向于LLIF的研究集中在技术上,可行性,围手术期效率,并立即进行术后X线检查。这项研究是为了报告长期的临床和影像学结果,并从易感LLIF程序的经验演变中识别学习。
方法:纳入所有在一个机构接受任何适应症的易发LLIF的连续患者(n=120)。人口统计,诊断,治疗,和结果数据通过前瞻性机构注册获取。回顾性分析确定了31个“程序化前”和89个“程序化后”易发LLIF方法,能够在早期和后期队列中进行比较。
结果:进行了187个测量的LLIF水平。手术时间,回缩时间,LLIF失血,平均住院150分钟,17分钟,50ml,2.2天,分别。79%的病例无并发症。术后髋关节屈曲无力占14%,12%的短暂性下肢无力,和10%的感官缺陷。在最后的随访中,背痛,最严重的腿部疼痛,Oswestry,EQ-5D健康状况改善了55%,46%,48%,51%,分别。在LLIF水平下,99%的矢状对齐得到改善或维持,平均节段前凸增加6.5°。在程序化前和后之间,仅腰大肌内回缩时间不同;程序化平均节省3.4分钟/水平(p=0.0371)。
结论:迄今为止最大的单中心易发LLIF经历和最长的随访表明,它几乎没有并发症,快速恢复,改善疼痛和功能,患者满意度高,术后平均1年和4年改善矢状面对齐。
OBJECTIVE: The prone transpsoas approach is a single-position alternative to traditional lateral lumbar interbody fusion (
LLIF). Earlier prone
LLIF studies have focused on technique, feasibility, perioperative efficiencies, and immediate postoperative radiographic alignment. This study was undertaken to report longer-term clinical and radiographic outcomes, and to identify learnings from experiential evolution of the prone LLIF procedure.
METHODS: All consecutive patients undergoing prone
LLIF for any indication at one institution were included (n = 120). Demographic, diagnostic, treatment, and outcomes data were captured via prospective institutional registry. Retrospective analysis identified 31 \'pre-proceduralization\' and 89 \'post-proceduralization\' prone LLIF approaches, enabling comparison across early and later cohorts.
RESULTS: 187 instrumented
LLIF levels were performed. Operative time, retraction time,
LLIF blood loss, and hospital stay averaged 150 min, 17 min, 50 ml, and 2.2 days, respectively. 79% of cases were without complication. Postoperative hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. At last follow-up, back pain, worst-leg pain, Oswestry, and EQ-5D health state improved by 55%, 46%, 48%, and 51%, respectively. 99% improved or maintained sagittal alignment with an average 6.5° segmental lordosis gain at LLIF levels. Only intra-psoas retraction time differed between pre- and post-proceduralization; proceduralization saved an average 3.4 min/level (p = 0.0371).
CONCLUSIONS: The largest single-center prone LLIF experience with the longest follow-up to-date shows that it results in few complications, quick recovery, improvements in pain and function, high patient satisfaction, and improved sagittal alignment at an average one year and up to four years postoperatively.