斜外侧腰椎椎间融合术间接减压治疗退行性腰椎管狭窄症

The indirect decompression effect of oblique lateral interbody fusion in the treatment of degenerative lumbar stenosis

目的探讨斜外侧腰椎椎间融合术（oblique lateral interboy fusion，OLIF）间接减压在退行性腰椎管狭窄症中的治疗作用。方法2014年10月至2016年11月应用OLIF技术联合或不联合后路椎弓根钉一棒系统内固定治疗轻中度腰椎管狭窄症患者23例，男9例，女14例；年龄41-74岁，平均（59．2±11．6）岁。均为单节段，L3.48例，L4.515例。影像学评估采用CT薄层扫描及二维重建片测量椎间孔纵径和面积，正中矢状位MRI测量椎间隙高度和椎管前后径，水平位MRI测量椎管前后径和面积。临床疗效采用视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估腰痛、下肢疼痛、下肢麻木及腰椎功能。结果所有患者术后均获得6个月以上的随访。术后椎间隙高度较术前增加了78．6％±13．4％；左侧椎间孔纵径增加了36．7％±7．8％，左侧椎间孔面积增加了36．6％±8．7％；右侧椎间孔纵径增加了40．7％±9．6％，右侧椎间孔面积增加了40．0％±8．9％；正中矢状位椎管前后径增加了32．6％±5．9％；水平位椎管前后径增加了34．4％±6．8％，椎管面积增加了47．5％±7．2％；手术前后比较，差异均有统计学意义。术前腰痛VAS评分为（6．2±1．7）分，下肢疼痛VAS评分为（5．6±1．4）分，下肢麻木VAS评分为（6．6±2．0）分，ODI为81．2％±18．2％；术后6个月随访，腰痛VAS评分为（1．1±0．5）分，下肢疼痛VAS评分为（0．8±003）分，下肢麻木VAS评分为（3．4±1．2）分，ODI为6．1％±2．0％；手术前后比较，差异均有统计学意义。结论OLIF技术间接减压治疗轻中度腰椎管狭窄症早期影像学指标改善明确，临床疗效显著；但远期结果仍需多中心、大样本的随访研究。

Objective To investigate the indirect decompression effect of oblique lateral interbody fusion （OLIF） in the treatment of mild to moderate degenerative lumbar stenosis. Methods From October 2014 to November 2016, 23 patients with mild to moderate lumbar spinal stenosis underwent OLIF combined with or without posterior pedicle screw fixation; 9 males and 14 females with average age of 59.2±11.6 years old; 8 cases at L3.4 segment and 15 cases at L4,5 segment. All cases were followed up for more than 6 months. Thin layer scanning of CT and two-dimensional reconstruction images were used to measure the verti- cal diameter and area of intervertebral foramen. Intervertebral disc height and spinal canal anteroposterior diameter were mea- sured on median sagittal MRI sequence, and the anteroposterior diameter and the cross-sectional area of the spinal canal were mea- sured on cross-sectional MRI sequence. The clinical effects were assessed by the visual analogue score （VAS） and the Oswestry disability index （ODI） for low back pain, lower limb pain and lower limb numbness. Results Compared with those measurements pre-operatively, the post-operative intervertebral disc height increased by 78.6%±13.4%. The post-operative left vertical diameter of intervertebral foramen increased by 36.7%±7.8%, and the post-operative left area of intervertebral foramen increased by 36.6%± 8.7%, and the post-operative right vertical diameter of intervertebral foramen increased by 40.7%±9.6%, and the post-operative right area of intervertebral foramen increased by 40.0%±8.9%. The post-operative anteroposterior diameter of sagittal spinal canal were increased 32.6% ± 5.9%, and the post-operative anteroposterior diameter of cross-sectional spinal canal were increased 34.4%±6.8%, and the post-operative cross-sectional area of the spinal canal were increased 47.5%±7.2%. All of the differences were statistically significant between pre-operative and post-operative measurements. The VAS score for low back pain was 6.2± 1.7 pre-operatively, and 1.1±0.5 post-operatively. The ODI for low back pain was 81.2%± 18.2% pre-operatively, and 6.1%±2.0% post-operatively. The VAS score for lower limb pain was 5.6±1.4 pre-operatively, and 0.8±0.3 post-operatively. And the VAS score for lower limb numbness was 6.6±2.0 pre-operatively, and 3.4±1.2 post-operatively. All of the differences were statistically signifi- cant between pre-operative and post-operative evaluations. Conclusion There were obvious radiological evidences and remark- able clinical effect of indirect decompression using OLIF technique in treatment of mild to moderate lumbar spinal stenosis at ear- ly post-operative stage. However further long-term follow-up studies with multicenter large sample were still needed.