斜外侧腰椎体间融合术初次术后邻近节段退变

Oblique lumbar interbody fusion for adjacent segment degeneration secondary to previous lumbar fusion

摘要:

[目的]评价斜外侧腰椎体间融合术(oblique lumbar interbody fusion, OLIF)治疗腰椎融合术后邻近节段退变的临床效果。[方法] 回顾性分析 2016 年 12 月—2019 年 12 月本院脊柱外科采用 OLIF 术治疗腰椎融合术后邻近节段退变 50 例患者的临床资料。[结果] 50 例患者均顺利完成手术，均未发生严重并发症。所有患者随访 12~16 个月，平均 (13.74±1.63) 个月。术后(12.66±3.64)周患者恢复完全负重活动。随访期间，患者术后疼痛逐步减缓，功能逐步改善。与术前相比较，末次随访时 VAS 和 ODI 评分均显著下降 (P＜0.05)。影像方面，与术前相比，末次随访时患者的腰椎前凸角 (LL) 显著增加 (P＜ 0.05)，而侧凸 Cobb 角显著减少 (P＜0.05)。至末次随访时，50 例患者再次手术椎间隙均达到骨性融合，椎间融合器无移位、 下沉。[结论]采用 OLIF 治疗腰椎融合术后邻近节段退变具有较好的安全性和有效性。

Abstract:

[Objective] To evaluate the clinical efficacy of oblique lumbar interbody fusion (OLIF) for treatment of adjacent lumbar de- generation secondary to previous lumbar fusion. [Methods] A retrospective study was done on 50 patients who received OLIF for adjacent segment degeneration after primary lumbar fusion in our department from December 2016 to December 2019. [Results] All the 50 patients were successfully operated without serious complications, and were followed up for 12~16 months, with an average of (13.74±1.63) months. The patient resumed full weight-bearing activity at (12.66±3.64) weeks postoperatively. During the follow-up period, pain gradually re- lieved, whereas function gradually improved. Both VAS and ODI scores significantly decreased at the last follow-up compared with those before operation (P＜0.05) . Radiographically, the lumbar lordosis angle (LL) significantly increased (P＜0.05) , whereas the Cobb angle of scoliosis decreased significantly at the last follow-up compared with those preoperatively (P＜0.05) . By the time of the latest follow-up, all the 50 patients had bony fusion in the involved segment, without displacement or subsidence of the cage. [Conclusion] The OLIF has good safety and efficacy in the treatment of adjacent segment degeneration after previous lumbar fusion.