斜腰椎椎体间融合术后腰椎交感神经链的发生率和风险因素。

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448536.268
Weerasak Singhatanadgige, Thanadol Tangdamrongtham, Worawat Limthongkul, Wicharn Yingsakmongkol, Stephen J Kerr, Teerachat Tanasansomboon, Vit Kotheeranurak
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引用次数: 0

摘要

目的:采用腹膜后入路进行斜行腰椎椎间融合术(OLIF)可能会导致与入路相关的并发症,如腰椎交感神经链损伤(LSCI)。虽然 LSCI 是 OLIF 的常见并发症,但由于缺乏特定的诊断标准,不同研究报告的发生率不尽相同。此外,关于 OLIF 术后交感神经链损伤风险因素的研究仍然有限。因此,本研究旨在描述接受OLIF术的腰椎退行性疾病患者交感神经链损伤的发生率,并确定其独立的风险因素:2020年10月至2023年8月期间,我院对200名因椎管狭窄、脊柱滑脱、退行性脊柱侧凸等退行性脊柱疾病在1至4个连续脊柱水平(L1-5)接受OLIF手术的患者进行了回顾性研究。我们排除了感染、外伤、肿瘤以及其他原因引起的下肢水肿/发热的患者。患者分为两组:有 LSCI 症状和无 LSCI 症状。采用单变量逻辑回归模型评估人口统计学数据、手术数据以及术前和术后参数与 LSCI 的相关性。变量的 p 值 结果:200 例患者中有 35 例(17.5%)在 OLIF 术后出现 LSCI 症状。多变量逻辑回归分析表明,牵引时间过长,尤其是超过 31.5 分钟,仍然是一个独立的风险因素(调整后的几率比为 12.59;pConclusion):本研究表明,回缩时间过长是 OLIF 术后发生 LSCI 的独立风险因素,尤其是当回缩时间超过 31.5 分钟时。在手术过程中保护腰交感神经链并尽量缩短牵拉时间对避免 OLIF 术后 LSCI 至关重要。
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Incidence and Risk Factors for Lumbar Sympathetic Chain Injury After Oblique Lumbar Interbody Fusion.

Objective: Oblique lumbar interbody fusion (OLIF), performed using a retroperitoneal approach, can lead to complications related to the approach, such as lumbar sympathetic chain injury (LSCI). Although LSCI is a common complication of OLIF, its reported incidence varies across studies due to an absence of specific diagnostic criteria. Moreover, research on the risk factors of postoperative sympathetic chain injuries after OLIF remains limited. Therefore, this study aimed to describe the incidence, and identify independent risk factors for LSCI, in patients with degenerative lumbar spinal diseases who underwent OLIF.

Methods: Between October 2020 and August 2023, a retrospective review was conducted at our institute on 200 patients who underwent OLIF at 1 to 4 consecutive spinal levels (L1-5) for degenerative spinal diseases including spinal stenosis, spondylolisthesis, degenerative scoliosis. We excluded those with infections, trauma, tumors, and lower extremity edema/warmth due to other causes. The patients were categorized into 2 groups: those with and without LSCI symptoms. Demographic data, operative data, and pre- and postoperative parameters were evaluated for their association with LSCI using a univariate logistic regression model. Variables with a p-value <0.1 in the univariate analysis were included in a multivariate model to identify the independent risk factors.

Results: Thirty-five of 200 patients (17.5%) developed LSCI symptoms after OLIF. Multivariate logistic regression analysis indicated that prolonged retraction time, particularly exceeding 31.5 miniutes, remained an independent risk factor (adjusted odds ratio, 12.59; p<0.001).

Conclusion: This study demonstrated that prolonged retraction time was an independent risk factor for LSCI following OLIF, particularly when it exceeded 31.5 minutes. Protecting the lumbar sympathetic chain during surgery and minimizing retraction time are crucial to avoiding LSCI following OLIF.

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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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