The mini-open anterolateral lumbar interbody fusion (MO-ALLIF)with self-anchored stand-alone cage in lumbar revision surgery / 中华骨科杂志

ABSTRACT

Objective To evaluate the safety and efficacy of the mini-open anterolateral lumbar interbody fusion (MO-ALLIF) in lumbar revision surgery.Methods Seventeen patients,seven male and ten female,who underwent revision lumbar surgeries using MO-ALLIF with self-anchored stand-alone polyetheretherketone (PEEK) cage in a single center between April 2013 and April 2016 were studied retrospectively.There were 14 of sing-level cases and 3 of double-level cases.Among them,11 cases were L4.5,4 cases were L3,4,5 cases were L5S1.There were 2 cases of cage migration,3 cases of pseudarthrosis,6 cases of recurrent lumbar disc herniation of the same level,and 6 cases of lumbar disc herniation on the adjacent level.The average age was 53.9±7.2 years (range,41-65 years).The clinical manifestation was low back pain and/or leg pain.The operation time,blood loss,and perioperative complications were evaluated.Oswestry disability index (ODI) and visual analog scale (VAS) score of leg and back pain were analyzed preoperatively and at each time point of follow-up postoperatively.Radiological evaluation including fusion,global lumbar lordosis,disc height on the operation level,foraminal height on the operation level,and subsidence were assessed.Results The average follow-up time was 22.7±8.6 months(12-48 months).Among the seventeen patients that participated in this study with a total of 20 segments,only one patient suffered from peritoneal rupture,but no symptom was observed after suturing.No other approach-related complications were found in all cases.The mean operation time was 74.0± 15.5 minutes.The average blood loss was 122.4±28.8 ml.All patients involved achieved solid fusion at the last followup (12 months post-operation) with no cage migration.Significant differences were observed between the pre-and post-operation status,with respect to the back pain VAS,leg pain VAS and ODI scores.The post-operative lumbar lordosis,disc height on the operation level and foraminal height on the operation level,were also significantly improved when compared with the pre-operative ones.Conclusion MO-ALLIF with self-anchored stand-alone PEEK cage is a modification of both anterior lumbar interbody fusion and oblique lumbar interbody fusion,which is safe and effective in some revision lumbar surgery with minor surgical trauma,low access-related complication rates,and satisfactory clinical and radiological results.