Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion.
Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion.
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DOI：
10.1097/brs.0b013e3181a4e3be
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发表时间：
2009-06-01
期刊：
影响因子：
3
通讯作者：
Tan, Seang Beng
中科院分区：
文献类型：
--
作者：
Peng, Chan Wearn Benedict;Yue, Wai Mun;Tan, Seang Beng
研究设计：前瞻性研究目的：微创（MIS）与开放性经椎间孔腰椎椎间融合术（TLIF）的临床和影像学结局比较。背景数据总结：开放性TLIF已进行多年，结果良好。MIS TLIF技术最近被引入，其目的是更小的伤口和更快的恢复。方法：从2004年到2006年，29例MIS TLIF与29例开放性TLIF配对。收集患者人口统计学和手术数据。在术前、术后6个月和2年，根据北美脊柱协会、奥斯韦斯特里残疾指数、简明36量表和视觉矫正评分进行临床评估。根据Bridwell分级评估2年时的融合率。结果：MIS和开放手术的平均年龄分别为54.1岁和52.5岁。两组均为24名女性和5名男性。透视时间（MIS：MIS组手术时间（MIS组：216.4 min，Open组：170.5 min，P <0.05）明显长于开腹组（P < 0.05）。微创组术中出血量（150 mL）明显少于开腹组（681 mL）（P < 0.05）。MIS组吗啡用量（17.4mg）明显少于Open组（35.7mg）（P < 0.05）。微创组住院时间（4d）较开放组（6.7d）短（P < 0.05）。微创组和开放组在6个月和2年时的奥斯韦斯特里功能障碍指数（P < 0.05）、背痛和下肢症状（北美脊柱协会和视觉矫形器评分，P < 0.05）以及生活质量评分（简表-36，P < 0.05）均有显著改善，但两组之间无显著差异。80%的MIS和86.7%的开放TLIF节段达到1级融合（P > 0.05）。结论：MIS TLIF具有与开放TLIF相似的良好长期临床结局和高融合率，并且具有术后初始疼痛更少、早期康复、住院时间更短和并发症更少的额外受益。
STUDY DESIGN: Prospective study.OBJECTIVE: Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF).SUMMARY OF BACKGROUND DATA: Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery.METHODS: From 2004-2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years.RESULTS: The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P < 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P < 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P < 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P < 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P < 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P < 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P < 0.05), and Quality of Life scores (Short Form-36, P < 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P > 0.05).CONCLUSION: MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.