Study Design: 

This was a retrospective comparative study.

Objective: 

To compare the likelihood of approach-related complications for patients undergoing single-level lateral lumbar interbody fusion (LLIF) at L4–L5 to those undergoing the procedure at upper lumbar levels.

Summary of Background Data: 

LLIF has been associated with a number of advantages when compared with traditional interbody fusion techniques. However, potential risks with the approach include vascular or visceral injury, thigh dysesthesias, and lumbar plexus injury. There are concerns of a higher risk of these complications at the L4–L5 level compared with upper lumbar levels.

Materials and Methods: 

A retrospective cohort review was completed for consecutive patients undergoing single-level LLIF between 2004 and 2019 by a single surgeon. Indication for surgery was symptomatic degenerative lumbar stenosis and/or spondylolisthesis. Patients were divided into 2 cohorts: LLIF at L4–L5 versus a single level between L1 and L4. Baseline characteristics, intraoperative complications, postoperative approach-related neurological symptoms, and patient-reported outcomes were compared and analyzed between the cohorts.

Results: 

A total of 122 were included in analysis, of which 58 underwent LLIF at L4–L5 and 64 underwent LLIF between L1 and L4. There were no visceral or vascular injuries or lumbar plexus injuries in either cohort. There was no significant difference in the rate of postoperative hip pain, anterior thigh dysesthesias, and/or hip flexor weakness between the cohorts (53.5% L4–L5 vs. 37.5% L1–L4; P=0.102). All patients reported complete resolution of these symptoms by 6-month postoperative follow-up.

Discussion: 

LLIF surgery at the L4–L5 level is associated with a similar infrequent likelihood of approach-related complications and postoperative hip pain, thigh dysesthesias, and hip flexor weakness when compared with upper lumbar level LLIF. Careful patient selection, meticulous use of real-time neuromonitoring, and an understanding of the anatomic location of the lumbar plexus to the working corridor are critical to success.

中文翻译：

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与上腰椎水平相比，L4-L5 外侧经腰肌腰椎间融合术后并发症和入路相关神经系统症状的发生率

学习规划： 

这是一项回顾性比较研究。

客观的： 

比较在 L4-L5 处接受单节段侧向腰椎椎间融合术 (LLIF) 的患者与在上腰椎接受手术的患者发生入路相关并发症的可能性。

背景数据摘要： 

与传统的椎间融合技术相比，LLIF 具有许多优点。然而，该方法的潜在风险包括血管或内脏损伤、大腿感觉迟钝和腰丛神经损伤。人们担心，与上腰椎水平相比，L4-L5 水平发生这些并发症的风险更高。

材料和方法： 

对 2004 年至 2019 年间由一位外科医生连续接受单级 LLIF 的患者完成了回顾性队列审查。手术指征是有症状的退行性腰椎狭窄和/或脊椎滑脱。患者被分为 2 个队列：L4-L5 的 LLIF 与 L1 和 L4 之间的单一水平。对两组之间的基线特征、术中并发症、术后入路相关神经系统症状以及患者报告的结果进行比较和分析。

结果： 

共有 122 例患者参与分析，其中 58 例在 L4-L5 期间接受了 LLIF，64 例在 L1 和 L4 之间接受了 LLIF。两组均未出现内脏或血管损伤或腰丛神经损伤。两组之间术后髋部疼痛、大腿前侧感觉迟钝和/或髋部屈肌无力的发生率没有显着差异（53.5% L4–L5 vs. 37.5% L1–L4；P = 0.102 ）。所有患者均报告术后 6 个月随访时这些症状完全缓解。

讨论： 

与上腰椎水平 LLIF 相比，L4-L5 水平的 LLIF 手术与入路相关并发症、术后髋部疼痛、大腿感觉迟钝和髋屈肌无力的可能性相似。仔细选择患者、仔细使用实时神经监测以及了解腰丛到工作通道的解剖位置对于成功至关重要。