Purpose: To assess the availability of oblique lumbar interbody fusion at the level of L5-S1 (OLIF51) and to choose ideal surgical corridor in OLIF51 by introducing V-line. Methods: The axial views through the center of L5-S1 disc were reviewed. We adopt 18mm as the width of the simulated surgical corridor. The midline of the surgical corridor is at the center of L5-S1 disc. According to the traction distance of the left iliac vein (LCIV) and psoas major (PM), we defined all the subjects as V (+) (traction-difficultly LCIV), V (-) (traction-friendly LCIV), P (+) (traction-difficultly PM) and P (-) (traction-friendly PM). V-line was defined as a straight line dividing equally the simulated surgical corridor. All cases were divided into 2 groups: The V-line (+) group, more than half of the LCIV region is located in ventral part of V-line; the V-line (-) group, more than half of the LCIV region is located in dorsal part of V-line. Multiple variables regressive analysis was conducted to analyze the independent risk factors of V-line (+). Results: V-line (+) was found in 36 (38.7%) patients and V-line (-) in 57 (61.3%). Incidence of V (+) and P (+) were 35.4% (33/93) and 30.1% (28/93), respectively. 16.1% (15/93) subjects processed V (+) and P (+) at the same time. The independent risk factor of V-line (+) were gender of male (P = 0.034, OR: 12.152) and medial position of LCIV (P < 0.001, OR: 265.085). High iliac crest was a significant independent protective factor (P = 0.001, OR: 0.750). Conclusions: Most patients were suitable for OLIF51. V-line could assess the injury risk of LCIV. Among male patients having the LCIV near the midline or the iliac crest relatively low, a surgical corridor external to the LCIV should be taken into consideration.
Objective This study aimed to find out the risk factors of postoperative moderate anemia (PMA) to develop a scoring scale for predicting the occurrence of PMA and to determine the recommended preoperative hemoglobin level in spinal tuberculosis (STB) patients. Methods A total of 223 STB patients who underwent focus debridement from January 2012 to March 2020 were enrolled in the study. The study cohort was divided into two groups owing to the occurrence of PMA. Moderate anemia was defined as a hemoglobin level of < 90 g/L. The clinical characteristics of STB patients who developed PMA were evaluated, and a scale was developed by logistic regression analysis. The performance of this scoring scale is prevalidated. Results Of the 223 patients, 76 developed PMA. Multivariate binary logistic regression analysis showed that body mass index, diabetes, low preoperative hemoglobin level, long operation time, and posterior approach were independent risk factors for PMA in STB patients. These significant items were assigned scores to create a scoring scale as to predicting PMA, and receiver operating characteristic (ROC) curve analysis implicated that the optimal cutoff score was 4 points. On the basis of the scoring scale, patients with scores within 0–3 points were defined as the low-risk group; those with scores within 4–6 points were defined as the moderate-risk group; and those with scores within 7–10 points were defined as the high-risk group. The perioperative decrease in hemoglobin level was 20.07 ± 10.47 g/L in the low-risk group, 24.44 ± 12.67 g/L in the moderate-risk group, and 29.18 ± 10.34 g/L in the high-risk group. Conclusion According to the scoring scale, patients with STB with a score of 0–3 points have a low risk of PMA, those with a score of 4–6 have a moderate risk, and those with a score of 7–10 have a high risk. The recommended preoperative hemoglobin levels for the low-, moderate-, and high-risk groups are 110, 115, and 120 g/L, respectively.
Background Many types of bone grafting have been reported for successful use in achieving anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the feasibility of none-structural bone grafting from comparing the advantages and disadvantages with structural bone grafting in the treatment of lumbar spinal tuberculosis. Patients and methods We retrospectively reviewed patients with lumbar spinal tuberculosis who had undergone none-structural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for back pain, the Oswestry Disability Index were collated before surgery and at follow-up. Results Both none-structural and structural bone grafting were associated with significant improvements in quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was in both two groups, without any associated complications. The operation duration and blood loss in none-structural bone grafting group was significantly less. The bone fusion rate was higher in structural bone grafting group. There were three complications in the none-structural bone grafting and four complications in the structural bone grafting group; the incidence of complications between the two groups was not significantly different. Conclusions Based on single-stage posterior debridement and pedicle screws fixation, none-structural bone grafting can achieve anterior column support with reducing surgical trauma, simplifying surgical procedure and decreasing intraoperative hemorrhage, but the lower rate of grafted bone fusion should be taken into consideration when choosing the aforementioned method. Key words Lumbar spinal tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; None-structural bone grafting; Structural bone grafting
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