Minimally Invasive Lateral Lumbar Interbody Fusion for Clinical Adjacent Segment Pathology
| Autor: | Kee-Yong Ha, Jong-Tae Park, Sang Il Kim, Young Hoon Kim, In-Soo Oh, Hyung-Ki Min, Hyung-Youl Park, Jun-Yeong Seo, Dong-Gune Chang |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Reoperation Pathology medicine.medical_specialty Visual Analog Scale Lordosis Decompression Visual analogue scale 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Minimally Invasive Surgical Procedures Medicine Orthopedics and Sports Medicine Aged 030222 orthopedics Lumbar Vertebrae medicine.diagnostic_test business.industry Magnetic resonance imaging Decompression Surgical medicine.disease Sagittal plane Oswestry Disability Index Spinal Fusion Treatment Outcome medicine.anatomical_structure Coronal plane Female Surgery Neurology (clinical) Thecal sac business 030217 neurology & neurosurgery |
| Zdroj: | Clinical Spine Surgery: A Spine Publication. 32:E426-E433 |
| ISSN: | 2380-0186 |
| Popis: | Study design This was a retrospective comparative study. Objective The main objective of this article was to evaluate the clinical and radiologic efficacies of minimally invasive lateral lumbar interbody fusion (LLIF) for clinical adjacent segment pathology (ASP). Summary of background data Minimally invasive techniques have been increasingly applied for spinal surgery. No report has compared LLIF with conventional posterior lumbar interbody fusion for clinical ASP. Methods Forty patients undergoing LLIF with posterior fusion (hybrid surgery) were compared with 40 patients undergoing conventional posterior lumbar interbody fusion (posterior surgery). The radiologic outcomes including indirect decompression in hybrid surgery group, and clinical outcomes such as the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were assessed. Postoperative major complications and reoperations were also compared between the 2 groups. Results Correction of coronal Cobb's angle and segmental lordosis in the hybrid surgery were significantly greater postoperatively (2.8 vs. 0.9 degrees, P=0.012; 7.4 vs. 2.5 degrees, P=0.009) and at the last follow-up (2.4 vs. 0.5 degrees, P=0.026; 4.8 vs. 0.8 degrees, P=0.016) compared with posterior surgery. As regards indirect decompression of the LLIF, significant increases in thecal sac (83.4 vs. 113.8 mm) and foraminal height (17.8 vs. 20.9 mm) were noted on postoperative magnetic resonance imaging. Although postoperative back VAS (4.1 vs. 5.6, P=0.011) and ODI (48.9% vs. 59.6%, P=0.007) were significantly better in hybrid surgery, clinical outcomes at the last follow-up were similar. Moreover, intraoperative endplate fractures developed in 17.7% and lower leg symptoms occurred in 30.0% of patients undergoing hybrid surgery. Conclusions Hybrid surgery for clinical ASP has advantages of segmental coronal and sagittal correction, and indirect decompression compared with conventional posterior surgery. However, LLIF-related complications such as endplate fracture and lower leg symptoms also developed. LLIF should be performed considering advantages and approach-related complications for the clinical ASP. |
| Databáze: | OpenAIRE |
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