Minimally invasive versus open transforaminal lumbar interbody fusion.
Minimally invasive versus open transforaminal lumbar interbody fusion.
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DOI：
10.4103/2152-7806.63905
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发表时间：
2010-05-31
影响因子：
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通讯作者：
Mason, Alexander
中科院分区：
文献类型：
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作者：
Villavicencio, Alan T;Burneikiene, Sigita;Mason, Alexander
背景技术背景：现有临床数据不足以比较微创（MI）和开放性入路经椎间孔腰椎椎间融合术（TLIF）。迄今为止，直接比较经椎间孔腰椎椎间融合术（TLIF）的微创（MI）和开放入路的文献很少。本研究的目的是直接比较这两种手术入路的安全性和有效性。材料和方法：分别对63名和76名患者进行了开放式或微创TLIF。所有连续微创TLIF病例均与开放性TLIF病例的可比队列匹配，使用三个变量：诊断、脊柱节段数量和既往腰椎手术史。患者接受疼痛性退行性椎间盘疾病治疗，伴或不伴椎间盘突出、脊椎滑脱和/或一个或两个脊柱节段狭窄。临床结局（自我报告测量，例如，视觉模拟评分（VAS）、患者满意度和MacNab标准）、手术数据（手术时间、估计失血量）、住院时间和并发症进行了评估。患者平均随访37.5个月。结果：开放性TLIF患者组术后VAS评分的平均变化更大（5.2 vs. 4.1）（P = 0.3）。开放性和微创TLIF组分别有67%和70%（P = 0.8）的患者的MacNab标准评分为优/良。开放和微创TLIF组的总体患者满意度分别为72.1%和64.5%（P = 0.4）。开放手术的总平均手术时间为214.9分钟，微创TLIF手术为222.5分钟（P = 0.5）。微创TLIF的平均估计失血量（163.0 ml）显著低于（P < 0.0001）开放入路（366.8 ml）。微创TLIF组的平均住院时间（3天）显著短于开放组（4.2天）（P = 0.02）。微创TLIF组神经功能缺损的总发生率为10.5%，而开放组为1.6%（P = 0.02）。结论：在选定的患者人群中，微创TLIF技术可提供与开放TLIF方法等同的长期临床结局。最小化组织破坏、减少失血和住院时间的潜在受益必须与学习曲线相关的神经损伤相关并发症发生率增加相权衡。
BACKGROUND: Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches.MATERIALS AND METHODS: Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab's criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months.RESULTS: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in theopen TLIF patient group (P = 0.3). MacNab's criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower (P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was 10.5% in the minimally invasive TLIF group compared to 1.6% in the open group (P = 0.02).CONCLUSIONS: Minimally invasive TLIF technique may provide equivalent long-term clinical outcomes compared to open TLIF approach in select population of patients. The potential benefit of minimized tissue disruption, reduced blood loss, and length of hospitalization must be weighted against the increased rate of neural injury-related complications associated with a learning curve.