臨床整形外科54巻11号

2019年11月発行

誌上シンポジウム 腰椎前方アプローチ—その光と影

Lateral Lumbar Interbody Fusion(LLIF)の利点と欠点

著者： 大鳥精司¹ 折田純久¹ 稲毛一秀¹ 志賀康浩¹ 乗本将輝¹ 海村朋孝¹ 牧聡¹ 古矢丈雄¹ 宮本卓弥¹ 佐藤崇司¹ 佐藤雅¹ 鈴木雅博¹ 榎本圭吾¹ 沖松翔¹ 金勤東¹ 髙岡宏光¹ 土屋流人¹ 穂積崇史¹ 水木誉凡¹ 井上雅寛¹ 青木保親¹ 江口和¹

所属機関： ¹千葉大学大学院医学研究院・整形外科学

ページ範囲：P.1135 - P.1142

　腰椎前方固定は近年，低侵襲化が進んできた．その中でも，lateral lumbar interbody fusion(LLIF)の特徴は，前方の矯正力が強いため，椎間板性腰痛，腰椎すべり症，成人脊柱変形に応用されている．後側弯症への高い矯正率，狭窄症に対する間接除圧手術が可能であり，術中の神経に低侵襲で，出血が少ないとされている．ここでは間接除圧手術の良好例を示す．しかしながら内臓損傷(腹膜，胸膜，大腸，尿管など)，血管損傷などの合併症も報告されており，本稿では尿管損傷に関して述べる．

参考文献

1) Ohtori S, Orita S, Yamauchi K, et al. Mini-open anterior retroperitoneal lumbar interbody fusion:oblique lateral interbody fusion for lumbar spinal degeneration disease. Yonsei Med J 2015;56(4):1051-9.

2) Fujibayashi S, Hynes RA, Otsuki B, et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 2015;40(3):E175-82. doi:10.1097/BRS.0000000000000703.

3) Sato J, Ohtori S, Orita S, et al. Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lateral interbody fusion for degenerated lumbar spondylolisthesis. Eur Spine J 2017;26(3):671-8.

4) Sembrano JN, Tohmeh A, Isaacs R, et al. Two-year comparative outcomes of MIS lateral and MIS transforaminal interbody fusion in the treatment of degenerative spondylolisthesis:Part I:Clinical findings. Spine (Phila Pa 1976) 2016;41(Suppl 8):S123-32.

5) Pawar AY, Hughes AP, Sama AA, et al. A comparative study of lateral lumbar interbody fusion and posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Asian Spine J 2015;9(5):668-74.

6) Gandhoke GS, Shin HM, Chang YF, et al. A cost-effectiveness comparison between open transforaminal and minimally invasive lateral lumbar interbody fusions using the incremental cost-effectiveness ratio at 2-year follow-up. Neurosurgery 2016;78(4):585-95.

7) Malham GM, Parker RM, Goss B, et al. Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages:results from a prospective cohort study. Eur Spine J 2015;24(Suppl 3):339-45.

8) Malham GM, Parker RM, Goss B, et al. Indirect foraminal decompression is independent of metabolically active facet arthropathy in extreme lateral interbody fusion. Spine (Phila Pa 1976) 2014;39(22):E1303-10. doi:10.1097/BRS.0000000000000551.

9) Kubota G, Orita S, Umimura T, et al. Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery:a case report. BMC Res Notes 2017;10(1):193.

10) Isiklar ZU, Lindsey RW, Coburn M. Ureteral injury after anterior lumbar interbody fusion:a case report. Spine (Phila Pa 1976) 1996;21(20):2379-82.

11) Hekal IA, Mohsen T, Nabeeh A. Ureteric injury after lumbosacral discectomy:a case report and review of the literature. J Trauma 2008;64(5):1387-91.

12) Fujibayashi S, Kawakami N, Asazuma T, et al. Complications associated with lateral interbody fusion:nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine (Phila Pa 1976) 2017;42(19):1478-84.

13) Parpala-Spårman T, Paananen I, Santala M, et al. Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol 2008;42(5):422-7.

14) Meirow D, Moriel EZ, Zilberman M, et al. Evaluation and treatment of iatrogenic ureteral injuries during obstetric and gynecologic operations for nonmalignant conditions. J Am Coll Surg 1994;178(2):144-8.

15) Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery:perspectives and indications from a retrospective, multicenter survey. Spine (Phila Pa 1976) 2017;42(1):55-62.