Objective To explore the influence of the height and position of the fusion cage on the indirect decompression effect of OLIF operation,and analyze the influencing factors for indirect decompression failure after OLIF operation.Methods The clinical da-ta of 103 patients with LSS who underwent OLIF from March 2019 to March 22 in our department were analyzed retrospectively.There were 157 surgical segments,including21 L2-3 segments,54 L3-4 segments,and 82 L4-5 segments;among them,63 cases underwent single-segment surgery,26 cases underwent two-stage surgery,and 14 cases underwent three-segment surgery.According to the X-ray film and MRI examination data before and after the operation,the following imaging indexes were measured:dural sac diameter,spinal canal diameter,cross sectional area of dural sac(CSA),spinal canal CSA,left and right subarticular diameter,left and right ligamen-tum flavum thickness and area,diameter of disc protrusion,disc height,segmental protrusion angle,intervertebral foramen height and intervertebral foramen area,etc.The influence of the height and placement position of the fuse on the above indicators was analyzed.All patients were followed up for more than six months to observe the incidence of indirect decompression failure within six months and analyze its influencing factors.Results Altogether 103 patients successfully completed OLIF surgery,and compared with preopera-tion,the pain VAS score of patients six months after surgery showed significant improvement(P＜0.001).Afterthe placementofafu-sion cage with a height of 14 mm(n =18),the improvement in indicators such as dural sac diameter,right ligamentum flavum thick-ness,and intervertebral disc protrusion diameter was significantly greater than that of fusion cages with a height of 10 mm(n =9)and 12mm(n =76)(P＜0.05).In terms of the position of fusion cage,the anterior position of fusion cage(n =48)could obtain better correction effect on segmental lordosis(P =0.041);however,the posterior placement of the fusion cage(n =109)could achieve a higher correction effect on the posterior edge height of the interverte-bral disc(P=0.018);at the same time,it could achieve a better effect on the left and right lower joint diameters(P=0.005,P= 0.019),and the thickness of the right ligamentum flavum was also significantly reduced(P=0.023).Multivariate logistic regression analysis showed that preoperative dural sac CSA(OR=0.952)and fusion cage position(OR =0.276)were independent influencing factors for indirect decompression failure in OLIF surgery.The ROC curve analysis showed that:① the best cutoff value of dural sac CSA before operation was 47.3 mm2,the sensitivity was 90.7%,the specificity was 82.9%,and AUC =0.869;② The best cutoff value of fusion cage position before operation was 4.8,sensitivity was 61.8%,specificity was 82.3%,and AUC =0.757.Conclusion OLIF operation is an effective indirect decompression operation for LSS,and the posterior placement of fusion cage can achieve better decompression effect.However,for the segment with dural sac CSA＜47.3 mm2 before operation,indirect decompression may not be suitable.The fusor height is related to the decompression effect of olif surgery,but is not an independent influencing factor for decom-pression failure.
关键词
斜外侧椎间融合术/腰椎管狭窄症/间接减压/融合器高度/融合器位置
Key words
oblique lateral interbody fusion/lumbar spinal stenosis/indirect decompression/fusor height/fusor position
维普
万方数据