Lateral Decubitus Anterior Lumbar Interbody Fusion at the L4-5 Level is a Safe Alternative to Lateral Lumbar Interbody Fusion in One- to Two-Level Lateral Decubitus Single Position Surgery.

IF 3.7 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2026-10-01 Epub Date: 2025-10-16 DOI:10.1097/BRS.0000000000005542

Nam V Huynh, J Alex Thomas, Brett A Braly, Cristiano M Menezes, Domenic Robinson, Emily Oettinger, Hannah Herrick, Aaron J Buckland

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引用次数: 0

Abstract

Study design: Retrospective review of prospectively, consecutively enrolled patients.

Objective: To assess differences in safety, efficiency and alignment between L-ALIF and LLIF at the L4-5 level in lateral single position surgery (L-SPS).

Summary of background data: The safety of L4-5 access in lateral lumbar interbody fusion (LLIF) may be limited by psoas, iliac crest, and vascular anatomy. Alternatively, lateral decubitus anterior lumbar interbody fusion (L-ALIF) can be used at the L4-5 level during L-SPS.

Materials and methods: Patients who underwent one to two-level L-SPS patients including L4-5 were analysed from seven institutions across three countries (Australia, Brazil, USA). Patients were grouped by the L4-5 interbody fusion technique: L-ALIF or LLIF. Demographics, procedural characteristics, complications, and sagittal alignment were analysed.

Results: Of 511 patients, 72 underwent L4-5 L-ALIF and 439 L4-5 LLIF. L-ALIF patients had more levels fused (1.65 vs. 1.25, P <0.001), longer operative time (115.78 vs. 89.08 min, P <0.001), and length of stay (LOS) (2.41 vs. 1.71 d, P <0.001). Propensity matching for demographics and levels fused (72 per group), demonstrated similar operative time (115.78 vs. 115.77 min, P =0.998), LOS (2.41 vs. 1.98 d, P =0.069), and blood loss (138.68 vs. 165.00 mL, P =0.408). L-ALIF patients had less postoperative (4.2% vs. 21.6%, P <0.001) and minor complications (1.4% vs. 15.0%, P =0.001), mainly attributable to less transient thigh dysaesthesia (0.0% vs. 6.4%, P =0.028). Intraoperative complications (2.8% vs. 2.5%, P =0.892), major postoperative complications (2.8% vs. 8.9%, P =0.077), reoperations within 90 days (2.8% vs. 7.1%, P =0.170) and cage revisions (1.4% vs. 1.6%, P =0.896) were similar. L-ALIF more accurately restored L4-S1 regional lordosis (36.1° vs. 29.7°, P =0.017) postoperatively, and enabled larger improvement in L4-5 segmental lordosis (change of +6.8° vs. +1.8°, P <0.001).

Conclusion: L-ALIF at L4-5 is a safe alternative to LLIF in L-SPS. In addition, L4-5 L-ALIF enables more accurate restoration of L4-S1 lordosis and effectively improves L4-5 segmental lordosis.

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腰4-5节段前路腰椎椎间融合术是1-2节段侧卧单体位手术中腰椎椎间融合术的安全选择。

研究设计：前瞻性、连续入组患者的回顾性研究。目的：评价L-ALIF和LLIF在L4-5节段侧位单体位手术（L-SPS）的安全性、有效性和对齐方面的差异。背景资料总结：腰外侧椎体间融合术（LLIF）中L4-5通路的安全性可能受到腰肌、髂骨和血管解剖的限制。另外，侧卧前路腰椎椎体间融合术（L-ALIF）可以在L4-5节段进行。方法：对来自3个国家（澳大利亚、巴西、美国）的7家机构的1-2级L-SPS患者（包括L4-5级）进行分析。患者按L4-5椎间融合技术分组：L-ALIF或LLIF。分析了人口统计学、手术特点、并发症和矢状位对齐。结果：511例患者中，72例行L4-5 L-ALIF， 439例行L4-5 LLIF。L-ALIF患者有更多的水平融合（1.65 vs.1.25, p）。结论：L4-5的L-ALIF是L-SPS中LLIF的安全替代品。此外，L4-5 L-ALIF可以更准确地恢复L4-S1前凸，有效改善L4-5节段性前凸。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

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