第29页。采用“外侧通道”进行L5-S1段微创斜腰椎体间融合术的新手术入路：临床系列和技术说明

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100653

Hae-Dong Jang PhD, MD , Jae Chul Lee MD, PhD , Byung-Joon Shin PhD

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引用次数: 0

摘要

腰骶区（L5-S1）椎间融合术有多种入路技术，每种方法都有其自身的优点、缺点和临床特点。微创斜腰椎体间融合术（MI-OLIF） L5-S1是为了克服传统融合技术的局限性而引入的，然而，由于某些病例的血管结构，MI-OLIF无法使用标准方法。目的介绍“侧通道”作为MI-OLIF L5-S1的可选手术入路，并通过临床病例系列报告手术技术的细节。研究设计/设置：临床系列和技术说明。患者样本纳入2015年7月至2022年10月期间因腰椎退行性疾病在我院行MI-OLIF L5-S1的患者。排除1年内有脊柱手术史及有感染、肿瘤或创伤的患者。在107例接受MI-OLIF L5-S1的患者中，26例（24.3%）接受了“侧廊”技术。我们回顾了需要额外操作的分支血管的类型和频率，并调查了术中血管损伤的频率。方法在本研究中，我们提出了一种新的手术入路，使用“外侧通道”进入左侧髂总静脉（LCIV）的外侧窗口，作为使用中央通道的标准技术的替代方法。在这两种方法中，LCIV的操作方式明显不同。中央通道法利用LCIV的内侧窗，将LCIV和左髂总动脉向外侧缩回。相比之下，“外侧通道”方法使用LCIV的外侧窗口，并向内侧收缩所有血管。它是LCIV外侧缘和左腰肌内侧缘之间的间隙。结果我们介绍了“外侧通道”的手术技术：1)患者体位、定位和皮肤切口，2)软组织剥离，3)血管剥离，4)椎间盘和终板准备，5)椎笼插入和定位，6)闭合和后路手术。42.3%的患者需要支血管结扎。需要结扎的分支血管类型为髂腰静脉（ILV） 7例（26.9%）和腰升静脉（ALV） 6例（23.1%）。在2例中结扎了上左室和上左室。所有患者均无术中血管损伤。结论：我们引入了“侧通道”作为L5-S1 MI-OLIF的替代入路，24.3%的患者实施了该入路，并报告了无血管并发症的良好结果。在42.3%的病例中，“侧通道”需要结扎ILV或ALV。“侧通道”入路似乎是一种很有前途的手术技术，即使在血管解剖结构排除了传统入路的情况下，也提供了可行性。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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P29. A novel surgical approach using the “lateral corridor” for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note

BACKGROUND CONTEXT

There are various approach techniques for the interbody fusion of the lumbosacral region (L5-S1), and each method has its own advantages, disadvantages, and clinical features. The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases.

PURPOSE

To introduce the “lateral corridor” as an optional surgical approach for MI-OLIF L5-S1 and report the details of the surgical technique with a clinical case series.

STUDY DESIGN/SETTING

A clinical series and technical note.

PATIENT SAMPLE

Patients who underwent MI-OLIF L5-S1 at our hospital between July 2015 and October 2022 for degenerative lumbar disease were included. Patients with confirmed spinal surgery history within 1 year and those with an infection, tumor, or trauma were excluded. Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the “lateral corridor” technique were included.

OUTCOME MEASURES

The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated.

METHODS

We propose a novel surgical approach using the “lateral corridor” to access the lateral window to the left common iliac vein (LCIV) in this study as an alternative to the standard technique using the central corridor. The LCIV is manipulated in significantly different ways between the two approaches. The central corridor method uses the medial window of the LCIV and retracts the LCIV and the left common iliac artery laterally. In contrast, the “lateral corridor” method uses the lateral window of the LCIV and retracts all vasculature medially. It is the space between the lateral margin of the LCIV and the medial margin of the left psoas muscle.

RESULTS

We introduced surgical technique using the "lateral corridor" in the following steps: 1) patient position, localization, and skin incision, 2) soft tissue dissection, 3) vascular dissection, 4) intervertebral disc and endplate preparation, 5) cage insertion and orientation, and 6) closure and posterior procedure. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of the ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries.

CONCLUSIONS

We introduced the "lateral corridor" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular complications. The “lateral corridor” necessitated ligation of the ILV or ALV in 42.3% of cases. The “lateral corridor” approach appears to be a promising surgical technique, offering feasibility even in instances where the vascular anatomy precludes the employment of the conventional approach.