Background

This study aimed to identify factors that can predict the need for rib resection in a minimally invasive, oblique retroperitoneal approach for upper lumbar interbody fusion (OLIF at L1-3) using modern tubular retractors.

Methods

Eighty-six patients, who underwent L1-2 and/or L2-3 OLIF at a single institution, were included. Decision for rib resection was made through intraoperative fluoroscopic view (true lateral view of the desired level). Patients were divided into two groups according to rib resection (rib resection and non-rib resection groups). Baseline demographics, surgical and radiographic data, including coronal/sagittal spinopelvic parameters and perioperative complications, were compared between the groups. Logistic regression analysis was performed to identify the factors predicting the need for rib resection.

Results

The study cohort comprised 31 patients in the rib resection group and 55 patients in the non-rib resection group. There was no significant inter-group difference in terms of the baseline demographics. A total of 79% patients undergoing the two-level (both L1-2 and L2-3) procedures were rib-resected, while 81.6% of the patients undergoing the L2-3 level alone were not rib-resected. Endplate injuries occurred more commonly in the non-rib resection group (3% vs. 14%). Pleural laceration was observed in 6% of the patients in the rib resection group. The mean T10-L2 kyphosis was larger in the rib resection group than in the non-rib resection group (14.9° vs. 6.6°, P = 0.031). Multivariate logistic regression analysis identified the following independent predictors of the need for rib resection: an L1-2 inclusive procedure; T10-L2 kyphosis > 15.9°; and the apex of the coronal curve located above L2.

Conclusion

: The need for rib resection should be expected when performing L1-2 inclusive procedure. Even in the L2-3 alone case, aggressive decision-making for intraoperative rib resection might be required for an appropriate tubular retractor position, especially for patients with thoracolumbar kyphosis and apex vertebra of the major coronal curve located above L2.

中文翻译：

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上腰椎（L1-2 和 L2-3）微创腹膜后入路斜侧椎间融合术中需要肋骨切除的预测因子

背景

本研究旨在确定可以预测使用现代管状牵开器通过微创斜腹膜后入路进行上腰椎椎间融合术（OLIF at L1-3）时是否需要进行肋骨切除的因素。

方法

其中包括在同一机构接受 L1-2 和/或 L2-3 OLIF 的 86 名患者。肋骨切除的决定是通过术中荧光镜检查（所需水平的真实侧视图）做出的。根据肋骨切除情况将患者分为两组（肋骨切除组和非肋骨切除组）。比较各组之间的基线人口统计学、手术和放射学数据，包括冠状/矢状脊柱骨盆参数和围手术期并发症。进行逻辑回归分析以确定预测需要肋骨切除的因素。

结果

研究队列包括肋骨切除组的 31 名患者和非肋骨切除组的 55 名患者。基线人口统计数据没有显着的组间差异。总共 79% 接受两级（L1-2 和 L2-3）手术的患者进行了肋骨切除，而仅接受 L2-3 级手术的患者中有 81.6% 没有进行肋骨切除。终板损伤在非肋骨切除组中更常见（3% vs. 14%）。肋骨切除组中有 6% 的患者出现胸膜撕裂。平均 T10-L2后凸肋骨切除组的角度大于非肋骨切除组的角度（14.9° vs. 6.6°，P = 0.031）。多变量逻辑回归分析确定了以下需要进行肋骨切除的独立预测因素：L1-2 包容性手术；T10-L2 后凸 > 15.9°；冠状曲线的顶点位于L2上方。

结论

：执行 L1-2 包容性手术时，应预计需要切除肋骨。即使在仅 L2-3 的病例中，也可能需要在术中做出肋骨切除的积极决策，以获得适当的管状牵开器位置，特别是对于胸腰椎后凸且主冠状曲线顶椎位于 L2 上方的患者。