Abstract
Background: The technique of lateral lumbar interbody fusion for the surgical treatment of patients with degenerative diseases of the lumbar spine was developed in the early 2000s. But at the same time in modern literature there is no uniform approach to the use this technique, clinical outcomes and radiological findings are contradictory. Aims: to conduct a multicenter analysis of clinical outcomes and instrumental data of direct lateral interbody fusion (DLIF) approach combined with transcutaneous pedicle fixation in patients with single-level degenerative disc diseases of the lumbar spine. Materials and methods: The study included 103 patients (63 men and 40 women, mean age 45.8±9.7 years) who underwent surgery followed by DLIF transcutaneous pedicle fixation. The surgery was performed at neurosurgical and vertebrological departments in Irkutsk (Russia), Omsk (Russia), and Astana (Kazakhstan). Dynamic observation and comprehensive clinical and instrumental evaluation of the treatment results were carried out for an 18-month period after surgery. Results: After the simultaneous decompressive-stabilizing intervention, in all patients we detected a decrease in the severity of pain syndrome on VAS — from 6.9±1.6 to 1.7±1.2 cm (p0.001), and improved quality of life index (Oswestry) — from 21.3±6.8 to 12.3±4.4% (p0.001). The instrumental methods of examination determined the effective indirect decompression: an increase in the size of interbody gap in the middle of its department compared with the preoperative value from 8.6±3.1 to 15.7±4.2 mm (p0.001) and an increase in the area of the intervertebral foramen (on the left with an average of 98.7±32.3 and 156.8±45.1 mm2, p0.001; on the right —99.7±37.3 to 153.4±38.7 mm2, p0.001). We also registered the restoration of both the segmental (from 10.2±3.8 to 13.6±6.7°, p0.001) and regional (from 32.8±5.9 to 48.2±7.3°, р0.001) lumbar lordosis. Complete interbody fusion was diagnosed in 87 (86.4%) patients. Complications were observed in 8.7% of cases. Conclusions: DLIF technique combined with transcutaneous transpedicular stabilization has high clinical efficacy confirmed by significant reduction in the severity of pain according to VAS. The studied approach improves the quality of life of patients by Oswestry index and reveals a low number of postoperative complications. The described simultaneous minimally invasive method of surgical treatment in patients with degenerative disc diseases allows to restore the sagittal profile of the lumbar spine and implement an effective stabilization of the operated vertebral-motor segments with a high degree of formation of interbody bone block.
Highlights
Методика direct lateral interbody fusion (DLIF) в сочетании с транскутанной транспедикулярной стабилизацией обладает высокой клинической эффективностью, подтвержденной значимым снижением выраженности болевого синдрома по визуальной аналоговой шкале (ВАШ), улучшением качества жизни пациентов по индексу Освестри и низким количеством послеоперационных осложнений
The technique of lateral lumbar interbody fusion for the surgical treatment of patients with degenerative diseases of the lumbar spine was developed in the early 2000s
Aims: to conduct a multicenter analysis of clinical outcomes and instrumental data of direct lateral interbody fusion (DLIF) approach combined with transcutaneous pedicle fixation in patients with single-level degenerative disc diseases of the lumbar spine
Summary
Мультицентровой анализ результатов применения прямого бокового межтелового спондилодеза (DLIF) и транскутанной транспедикулярной фиксации у пациентов 149 с дегенеративными заболеваниями межпозвонковых дисков поясничного отдела позвоночника Обоснование. Методика бокового поясничного межтелового спондилодеза для хирургического лечения пациентов с дегенеративными заболеваниями поясничного отдела позвоночника разработана в начале 2000-х годов. Цель исследования: провести мультицентровой анализ клинических исходов и инструментальных данных использования методики прямого бокового межтелового спондилодеза (Direct lateral interbody fusion, DLIF) в сочетании с транскутанной транспедикулярной фиксацией у пациентов с одноуровневыми дегенеративными заболеваниями межпозвонковых дисков поясничного отдела позвоночника. (Для цитирования: Бывальцев В.А., Калинин А.А., Акшулаков С.К., Кривошеин А.Е., Керимбаев Т.Т., Степанов И.А. Мультицентровой анализ результатов применения прямого бокового межтелового спондилодеза (DLIF) и транскутанной транспедикулярной фиксации у пациентов с дегенеративными заболеваниями межпозвонковых дисков поясничного отдела позвоночника. Transpedicular Fixation in Patients with Degenerative Disc Diseases of the Lumbar Spine
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