微創腰椎椎間融合術的臨床應用進展_West China Medical Journal

Authors：

 徐練 ,  孔清泉

四川大學華西醫院骨科（成都，610041）;

Corresponding?author：

孔清泉, Email: kongspine@126.com

Keywords：

腰椎; 微創技術; 椎間融合術; 前路; 后路

DOI：

10.7507/1002-0179.20140175

Video：

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Abstract Full text Figures/Tables Video References Cited by

腰椎融合術是治療腰椎退變性疾患、腰椎感染、創傷、腫瘤以及腰骶部畸形等疾病的傳統術式，其開展歷史已近百年。然而，由于傳統腰椎融合術需對肌肉等軟組織進行廣泛剝離和長時間牽拉，致使術后慢性腰痛等并發癥的發生率明顯增加。近年來，伴隨脊柱微創外科技術的飛速發展，結合傳統腰椎融合術與微創技術的全新手術方式——微創腰椎椎間融合術應運而生。其優勢在于能獲得與傳統腰椎融合術相同或相近手術療效的前提下，盡可能減少對椎旁軟組織的損傷，同時減少術中失血量，縮短術后住院及康復時間，降低術中、術后相關并發癥的發生率等。因而近年來也受到了越來越多的脊柱工作者的青睞。現就該類技術的臨床應用現狀及進展作一綜述。

Citation： 徐練, 孔清泉. 微創腰椎椎間融合術的臨床應用進展. West China Medical Journal, 2014, 29(3): 582-587. doi: 10.7507/1002-0179.20140175 Copy

1.	Capener N. Spondylolisthesis[J]. Br J Surg, 1932, 19(75):374-386.
2.	Obenchain TG. Laparoscopic lumbar discectomy:case report[J]. J Laparoendosc Surg, 1991, 1(3):145-149.
3.	Zucherman JF, Zdeblick TA, Bailey SA, et al. Instrumented laparoscopic spinal fusion. Preliminary Results[J]. Spine J, 1995, 20(18):2029-2034.
4.	Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 1997, 22(6):691-699.
5.	Wiltfong RE, Bonob CM, Sharand AD, et al. Lumbar interbody fusion:review of history, complications, and outcome comparisons among methods[J]. Curr Orthop Pract, 2012, 23(3):193-202.
6.	Kim JS, Choi WG, Lee SH. Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis:minimum 5-year follow-up[J]. Spine J, 2010, 10(5):404-409.
7.	Saraph V, Lerch C, Walochnik N, et al. Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion[J]. Eur Spine J, 2004, 13(5):425-431.
8.	Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion:laparoscopic versus mini anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2000, 25(20):2682-2687.
9.	Chung SK, Lee SH, Lim SR, et al. Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up[J]. Eur Spine J, 2003, 12(6):613-617.
10.	Kaiser MG, Haid RW, Subach BR, et al. Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion:a retrospective review[J]. Neurosurgery, 2002, 51(1):97-103.
11.	Tsahtsarlis A, Efendy JL, Mannion RJ, et al. Complications from minimally invasive lumbar interbody fusion:experience from 100 patients[J]. J Clin Neurosci, 2013, 20(6):813-817.
12.	Silvestre C, Mac-Thiong JM, Hilmi R, et al. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbar interbody fusion in 179 patients[J]. Asian Spine J, 2012, 6(2):89-97.
13.	Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care[J]. J Neurosurg, 1953, 10(2):154-168.
14.	方曉輝, 丁亮華, 何雙華. 微創腰椎椎間融合技術及其臨床應用進展[J]. 中國脊柱脊髓雜志, 2012, 22(4):362-366.
15.	Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion[J]. Spine J, 2005, 30(16 Suppl):S33-S43.
16.	Fourney DR, Dettori JR, Norvell DC, et al. Does minimal access tubular assisted spine surgery increase or decrease complications in spine decompression or fusion[J]. Spine (Phila Pa 1976), 2010, 35(Suppl 9):57-65.
17.	Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach[J]. Spine (Phila Pa 1976), 2007, 32(5):537-543.
18.	代鳳雷, 劉藝, 李欽亮, 等. 微創單側經皮PLIF術治療腰椎退變的近期療效[J]. 江蘇醫藥, 2012, 38(11):1293-1295.
19.	Logroscino CA, Proietti L, Pola E, et al. A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities[J]. Eur Spine J, 2011, 20(Suppl 1):S41-S45.
20.	Harms J, Jeszensky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion[J]. Orthoped Traumatol, 1998, 6(2):88-99.
21.	Kevin T, Foley LT, Holly LT, et al. Minimally invasive lumbar fusion[J]. Spine J, 2003, 28(Suppl 15):26-35.
22.	邱北溟. 微創TLIF技術的臨床應用及進展[J]. 重慶醫學, 2011, 40(11):1118-1120.
23.	肖波, 毛克亞, 王巖, 等. 微創經椎間孔腰椎椎體間融合術與傳統后路腰椎椎體間融合術并發癥的比較分析[J]. 脊柱外科雜志, 2013, 11(1):23-27.
24.	Taylor J, Pupin P, Delajoux S, et al. Device for intervertebral assisted motion:technique and initial results[J]. Neurosurg Focus, 2007, 22(1):E6.
25.	Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2001, 26(5):567-571.
26.	Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion:a review of techniques and outcomes[J]. Spine (Phila Pa 1976), 2010, 35(Suppl 26):S294-S301.
27.	Adogwa O, Parker SL, Bydon A, et al. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion:2-year assessment of narcotic use, return to work, disability, and quality of Life[J]. J Spinal Disord Tech, 2011, 24(8):479-484.
28.	Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2009, 34(13):1385-1389.
29.	湯優, 張為, 申勇, 等. 經Quadrant通道下微創TLIF與開放TLIF治療腰椎退變性疾病療效的對比研究[J]. 中國矯形外科雜志, 2012, 20(21):1935-1938.
30.	Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion[J]. Eur Spine J, 2012, 21(11):2265-2270.
31.	Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults[J]. J Clin Neurosci, 2012, 19(1):111-114.
32.	Pimenta L. Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery[R]. Belo Horizonte:VⅢ Brazilian Spine Society Meeting, 2001.
33.	Darren L, Bergey MD, Alan T, et al. Endoscopic lateral transpsoas approach to the lumbar[J]. Spine J, 2004, 29(15):1681-1688.
34.	Ozgur BM, Aryan HE, Pimenta L, et al. Extreme lateral interbody fusion (XLIF):a novel surgical technique for anterior lumbar interbody fusion[J]. Spine J, 2006, 6(4):435-443.
35.	Smith WD, Youssef JA, Christian G, et al. Lumbarized sacrum as a relative contraindication for lateral transpsoas interbody fusion at L5-6[J]. J Spinal Disord Tech, 2012, 25(5):285-291.
36.	Berjano P, Lamartina C, Far LA. (XLIF) in adult scoliosis[J]. Eur Spine J, 2013, 22(Suppl 2):S242-S253.
37.	Sharma AK, Kepler CK, Girardi FP, et al. Lateral lumbar interbody fusion:clinical and radiographic outcomes at 1 year:a preliminary report[J]. J Spinal Disord Tech, 2011, 24(4):242-250.
38.	Malham GM, Ellis NJ, Parker RM, et al. Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions[J]. Sci World J, 2012(12):246989.
39.	Youssef JA, Mcafee PC, Patty CA, et al. Minimally invasive surgery:lateral approach interbody fusion:results and review[J]. Spine J, 2010, 35(Suppl 26):S302-S311.
40.	Acosta FL, Liu J, Slimack N, et al. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults:a radiographic study[J]. J Neurosurg Spine, 2011, 15(1):92-96.
41.	Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases[J]. Spine J, 2011, 36(1):26-32.
42.	Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese[J]. J Spinal Disord Tech, 2010, 23(6):393-397.
43.	Mcafee PC, Shucosky E, Chotikul L, et al. Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity:25 consecutive cases[J]. Intern J Spine Surg, 2013, 7(1):e8-e19.
44.	Cragg A, Carl A, Casteneda F, et al. New percutaneous access method for minimally invasive anterior lumbosacral surgery[J]. J Spinal Disord Tech, 2004, 17(1):21-28.
45.	Marotta N, Cosar M, Pimenta L, et al. A novel minimally invasive presacral approach and instrumentation technique for anterior L5-S1 intervertebral discectomy and fusion:technical description and case presentations[J]. Neurosurg Focus, 2006, 20(1):E9.
46.	Aryan HE, Newman CB, Gold JJ, et al. Percutaneous axial lumbar interbody fusion (AxiaLIF) of the L5-S1 segment:initial clinical and radiographic experience[J]. Minim Invasive Neurosurg, 2008, 51(4):225-230.
47.	Boachie-Adjei O, Cho W, King AB. Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis[J]. Eur Spine J, 2013, 22(Suppl 2):S225-S231.
48.	William D, Tobler MD, Peter C, et al. Minimally invasive axial presacral L5-S1 interbody fusion[J]. Spine (Phila Pa 1976), 2011, 36(20):E1296-E1301.
49.	Tobler WD, Ferrara LA. The presacral retroperitoneal approach for axial lumbar interbody fusion:a prospective study of clinical outcomes, complications and fusion rates at a follow-up of two years in 26 patients[J]. J Bone Joint Surg, 2011, 93(7):955-960.
50.	Anand N, Baron EM, Thaiyananthan G, et al. Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis:a technique and feasibility study[J]. J Spinal Disord Tech, 2008, 21(7):459-467.
51.	Patil SS, Lindley EM, Patel VV, et al. Clinical and radiological outcomes of axial lumbar interbody fusion[J]. Orthopedics, 2010, 33(12):883.
52.	Whang PG, Sasso RC, Patel VV, et al. Comparison of axial and anterior interbody fusions of the L5-S1 segment:a retrospective cohort analysis[J]. J Spinal Disord Tech, 2013, 26(8):437-443.
53.	Bradley WD, Hisey MS, Verma-Kurvari S, et al. Minimally invasive trans-sacral approach to L5-S1 interbody fusion:Preliminary results from 1 center and review of the literature[J]. Int J Spine Surg, 2012, 6(1):110-114.

1. Capener N. Spondylolisthesis[J]. Br J Surg, 1932, 19(75):374-386.
2. Obenchain TG. Laparoscopic lumbar discectomy:case report[J]. J Laparoendosc Surg, 1991, 1(3):145-149.
3. Zucherman JF, Zdeblick TA, Bailey SA, et al. Instrumented laparoscopic spinal fusion. Preliminary Results[J]. Spine J, 1995, 20(18):2029-2034.
4. Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 1997, 22(6):691-699.
5. Wiltfong RE, Bonob CM, Sharand AD, et al. Lumbar interbody fusion:review of history, complications, and outcome comparisons among methods[J]. Curr Orthop Pract, 2012, 23(3):193-202.
6. Kim JS, Choi WG, Lee SH. Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis:minimum 5-year follow-up[J]. Spine J, 2010, 10(5):404-409.
7. Saraph V, Lerch C, Walochnik N, et al. Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion[J]. Eur Spine J, 2004, 13(5):425-431.
8. Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion:laparoscopic versus mini anterior lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2000, 25(20):2682-2687.
9. Chung SK, Lee SH, Lim SR, et al. Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up[J]. Eur Spine J, 2003, 12(6):613-617.
10. Kaiser MG, Haid RW, Subach BR, et al. Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion:a retrospective review[J]. Neurosurgery, 2002, 51(1):97-103.
11. Tsahtsarlis A, Efendy JL, Mannion RJ, et al. Complications from minimally invasive lumbar interbody fusion:experience from 100 patients[J]. J Clin Neurosci, 2013, 20(6):813-817.
12. Silvestre C, Mac-Thiong JM, Hilmi R, et al. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbar interbody fusion in 179 patients[J]. Asian Spine J, 2012, 6(2):89-97.
13. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care[J]. J Neurosurg, 1953, 10(2):154-168.
14. 方曉輝, 丁亮華, 何雙華. 微創腰椎椎間融合技術及其臨床應用進展[J]. 中國脊柱脊髓雜志, 2012, 22(4):362-366.
15. Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion[J]. Spine J, 2005, 30(16 Suppl):S33-S43.
16. Fourney DR, Dettori JR, Norvell DC, et al. Does minimal access tubular assisted spine surgery increase or decrease complications in spine decompression or fusion[J]. Spine (Phila Pa 1976), 2010, 35(Suppl 9):57-65.
17. Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach[J]. Spine (Phila Pa 1976), 2007, 32(5):537-543.
18. 代鳳雷, 劉藝, 李欽亮, 等. 微創單側經皮PLIF術治療腰椎退變的近期療效[J]. 江蘇醫藥, 2012, 38(11):1293-1295.
19. Logroscino CA, Proietti L, Pola E, et al. A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities[J]. Eur Spine J, 2011, 20(Suppl 1):S41-S45.
20. Harms J, Jeszensky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion[J]. Orthoped Traumatol, 1998, 6(2):88-99.
21. Kevin T, Foley LT, Holly LT, et al. Minimally invasive lumbar fusion[J]. Spine J, 2003, 28(Suppl 15):26-35.
22. 邱北溟. 微創TLIF技術的臨床應用及進展[J]. 重慶醫學, 2011, 40(11):1118-1120.
23. 肖波, 毛克亞, 王巖, 等. 微創經椎間孔腰椎椎體間融合術與傳統后路腰椎椎體間融合術并發癥的比較分析[J]. 脊柱外科雜志, 2013, 11(1):23-27.
24. Taylor J, Pupin P, Delajoux S, et al. Device for intervertebral assisted motion:technique and initial results[J]. Neurosurg Focus, 2007, 22(1):E6.
25. Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2001, 26(5):567-571.
26. Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion:a review of techniques and outcomes[J]. Spine (Phila Pa 1976), 2010, 35(Suppl 26):S294-S301.
27. Adogwa O, Parker SL, Bydon A, et al. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion:2-year assessment of narcotic use, return to work, disability, and quality of Life[J]. J Spinal Disord Tech, 2011, 24(8):479-484.
28. Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2009, 34(13):1385-1389.
29. 湯優, 張為, 申勇, 等. 經Quadrant通道下微創TLIF與開放TLIF治療腰椎退變性疾病療效的對比研究[J]. 中國矯形外科雜志, 2012, 20(21):1935-1938.
30. Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion[J]. Eur Spine J, 2012, 21(11):2265-2270.
31. Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults[J]. J Clin Neurosci, 2012, 19(1):111-114.
32. Pimenta L. Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery[R]. Belo Horizonte:VⅢ Brazilian Spine Society Meeting, 2001.
33. Darren L, Bergey MD, Alan T, et al. Endoscopic lateral transpsoas approach to the lumbar[J]. Spine J, 2004, 29(15):1681-1688.
34. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme lateral interbody fusion (XLIF):a novel surgical technique for anterior lumbar interbody fusion[J]. Spine J, 2006, 6(4):435-443.
35. Smith WD, Youssef JA, Christian G, et al. Lumbarized sacrum as a relative contraindication for lateral transpsoas interbody fusion at L5-6[J]. J Spinal Disord Tech, 2012, 25(5):285-291.
36. Berjano P, Lamartina C, Far LA. (XLIF) in adult scoliosis[J]. Eur Spine J, 2013, 22(Suppl 2):S242-S253.
37. Sharma AK, Kepler CK, Girardi FP, et al. Lateral lumbar interbody fusion:clinical and radiographic outcomes at 1 year:a preliminary report[J]. J Spinal Disord Tech, 2011, 24(4):242-250.
38. Malham GM, Ellis NJ, Parker RM, et al. Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions[J]. Sci World J, 2012(12):246989.
39. Youssef JA, Mcafee PC, Patty CA, et al. Minimally invasive surgery:lateral approach interbody fusion:results and review[J]. Spine J, 2010, 35(Suppl 26):S302-S311.
40. Acosta FL, Liu J, Slimack N, et al. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults:a radiographic study[J]. J Neurosurg Spine, 2011, 15(1):92-96.
41. Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases[J]. Spine J, 2011, 36(1):26-32.
42. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese[J]. J Spinal Disord Tech, 2010, 23(6):393-397.
43. Mcafee PC, Shucosky E, Chotikul L, et al. Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity:25 consecutive cases[J]. Intern J Spine Surg, 2013, 7(1):e8-e19.
44. Cragg A, Carl A, Casteneda F, et al. New percutaneous access method for minimally invasive anterior lumbosacral surgery[J]. J Spinal Disord Tech, 2004, 17(1):21-28.
45. Marotta N, Cosar M, Pimenta L, et al. A novel minimally invasive presacral approach and instrumentation technique for anterior L5-S1 intervertebral discectomy and fusion:technical description and case presentations[J]. Neurosurg Focus, 2006, 20(1):E9.
46. Aryan HE, Newman CB, Gold JJ, et al. Percutaneous axial lumbar interbody fusion (AxiaLIF) of the L5-S1 segment:initial clinical and radiographic experience[J]. Minim Invasive Neurosurg, 2008, 51(4):225-230.
47. Boachie-Adjei O, Cho W, King AB. Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis[J]. Eur Spine J, 2013, 22(Suppl 2):S225-S231.
48. William D, Tobler MD, Peter C, et al. Minimally invasive axial presacral L5-S1 interbody fusion[J]. Spine (Phila Pa 1976), 2011, 36(20):E1296-E1301.
49. Tobler WD, Ferrara LA. The presacral retroperitoneal approach for axial lumbar interbody fusion:a prospective study of clinical outcomes, complications and fusion rates at a follow-up of two years in 26 patients[J]. J Bone Joint Surg, 2011, 93(7):955-960.
50. Anand N, Baron EM, Thaiyananthan G, et al. Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis:a technique and feasibility study[J]. J Spinal Disord Tech, 2008, 21(7):459-467.
51. Patil SS, Lindley EM, Patel VV, et al. Clinical and radiological outcomes of axial lumbar interbody fusion[J]. Orthopedics, 2010, 33(12):883.
52. Whang PG, Sasso RC, Patel VV, et al. Comparison of axial and anterior interbody fusions of the L5-S1 segment:a retrospective cohort analysis[J]. J Spinal Disord Tech, 2013, 26(8):437-443.
53. Bradley WD, Hisey MS, Verma-Kurvari S, et al. Minimally invasive trans-sacral approach to L5-S1 interbody fusion:Preliminary results from 1 center and review of the literature[J]. Int J Spine Surg, 2012, 6(1):110-114.

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