Латеральный косой (препсоас) доступ при выполнении поясничного спондилодеза (обзор)

Поясничный спондилодез — одна из самых частых операций в спинальной хирургии. Для ее выполнения в настоящее время все чаще используется переднебоковой (препсоас) доступ (oblique lumbar interbody fusion, OLIF), сочетающий в себе высокую эффективность и безопасность для пациента. Однако информации о клинических и рентгенологических результатах применения данной методики пока недостаточно.

Цель исследования — проанализировать безопасность и эффективность методики OLIF при лечении широкого спектра патологий поясничного отдела позвоночника по данным литературных источников.

Материалы и методы. Проведен анализ литературы по теме результативности методики OLIF с использованием электронных баз данных Ovid Medline, PubMed, eLIBRARY.RU. Поиск осуществляли по ключевым словам Oblique Lumbar Interbody Fusion, OLIF, Anterior to Psoas Lumbar Interbody Fusion, ATP.

Результаты. В окончательный анализ включено 17 источников, в которых проанализировано лечение 2900 пациентов, отмечено 403 осложнения (13,9%). При этом частота тяжелых стойких осложнений составила менее 1%. На основании полученных данных проведено сопоставление клинических и рентгенологических результатов OLIF с аналогичными показателями при использовании других вариантов поясничного спондилодеза.

Заключение. OLIF является эффективным, универсальным и минимально травматичным вариантом поясничного спондилодеза с относительно небольшим количеством осложнений, что дает ему преимущество по сравнению с другими ретроперитонеальными доступами. Тем не менее техника OLIF не позволяет полностью избежать осложнений, связанных с вентральным доступом, и не во всех случаях может обеспечить адекватную декомпрессию позвоночного канала. Роль вентрального доступа в хирургии деформаций позвоночника также остается ограниченной, адекватная коррекция деформации в большинстве случаев возможна лишь в сочетании с дорсальным доступами.

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