Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.     

两种术式治疗3节段退变性腰椎管狭窄症早期疗效比较

目的比较后路椎体间融合术(PLIF)与微创通道辅助下经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗3节段退变性腰椎管狭窄症的早期疗效。方法按手术方式不同,将60例3节段退变性腰椎管狭窄症患者分为PLIF组(36例)和MIS-TLIF组(24例),比较两组手术时间、术中出血量、住院时间和随访时腰背疼痛VAS评分、下肢疼痛VAS评分、ODI评分、SF-36评分以及术后并发症。结果患者均获得随访,PLIF组随访12~20个月,MIS-TLIF组随访13~21个月。手术时间、术中出血量、住院时间两组比较差异均有统计学意义(P<0.05)。腰背疼痛VAS评分、下肢疼痛VAS评分、SF-36评分、ODI评分两组术后6、12个月与术前比较差异均有统计学意义(P<0.05)。术后6、12个月下肢疼痛VAS评分、SF-36评分、ODI评分两组比较差异均无统计学意义(P>0.05)。腰背疼痛VAS评分术后6个月两组比较差异有统计学意义(P<0.05),但术后12个月两组比较差异无统计学意义(P>0.05)。PLIF组发生脑脊液漏3例,MIS-TLIF组发生脑脊液漏1例、浅表手术部位感染2例,两组并发症例数比较差异无统计学意义(P>0.05)。影像学显示,两组患者手术节段均在术后1年内获得良好的节段融合。结论与PLIF比较,MIS-TLIF治疗3节段退变性腰椎管狭窄症出血量少、住院时间短、术后腰背疼痛症状改善速度快。     

退行性脊柱侧凸对MIS-TLIF治疗腰椎管狭窄症疗效影响

目的:评估退行性脊柱侧凸对微创经椎间孔入路腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎管狭窄症的手术难度及术后疗效的影响。方法:自2016年9月至2019年9月,采用MIS-TLIF手术治疗腰椎管狭窄症患者52例,男16例,女36例,年龄42～71(63.44±5.96)岁,病程1.5～6.5(3.69±1.10)年。52例患者均有下肢根性痛或麻木症状,其中41例患者有间歇性跛行症状。51例均为单节段狭窄,狭窄节段:L4,5节段31例,L5S1节段21例。依据是否合并退行性脊柱侧凸分为侧凸组18例(退行性脊柱侧凸合并腰椎管狭窄),狭窄组34例(单纯腰椎管狭窄)。记录围手术期相关数据和术后并发症,通过CT评估术后椎间植骨融合情况,采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者疼痛和腰椎功能改善情况。结果:51例患者均获随访,随访时间12～36(19.58±5.33)个月。手术时间、术中出血量狭窄组优于侧凸组(P0.05);两组间术后引流量、术后血红蛋白及C-反应蛋白、术后下地时间、出院时间、出院及随访时VAS评分、术后3个月及随访时ODI评分、术后并发症和椎间植骨融合率比较差异无统计学意义(P0.05)。结论:对于行MIS-TLIF手术的腰椎管狭窄症患者,退行性脊柱侧凸三维畸形,可导致手术时间延长,出血增多。但是对患者术后症状的缓解,并发症的发生和腰椎功能的恢复并无明显影响。     

显微内镜辅助经皮微创椎间孑L入路腰椎椎体间融合术治疗腰椎退行性疾病

背景：传统开放椎间孔入路腰椎椎体间融合术（transforaminal lumbar interbody fusion,TLIF）由于剥离肌肉广泛及长时间牵拉,可导致部分患者持续性腰背痛。随着脊柱微创技术的发展,采用微创手段实施TLIF技术取得了良好的临床效果,但小切口经扩张通道系统的微创TLIF仍不可避免存在肌肉剥离,需探索更加微创的手术方式。 目的：探讨显微内镜辅助经皮微创TLIF治疗腰椎退行性疾病的近期疗效及安全性。 方法：2010年9月至2011年7月,72例腰椎退行性疾病患者接受了单节段TLIF手术,腰椎失稳症36例,腰椎管狭窄症25例,复发型腰椎间盘突出症11例。采用VIPER经皮椎弓根螺钉系统结合椎间盘镜下TLIF手术32例（微创组）,传统开放TLIF手术40例（开放组）,对两组患者近期临床疗效、并发症、术中射线暴露指标等进行比较。 结果：所有患者均获随访,随访时间6-15个月,平均9个月。两组手术时间无明显统计学差异（P〉0．05）,微创组术中出血量、伤口引流量、住院天数、术后应用镇痛药剂量均明显低于开放组（P〈0．01）;微创组术中射线暴露时间及剂量高于开放组（P〈0．01）;微创组术后疼痛（VAS评分）及ODI功能指数较开放组明显降低（P〈0．01）。微创组出现术中减压错误1例,置钉位置错误1例,导针穿透椎体前壁1例,硬膜撕裂1例;开放组出现术中硬膜撕裂3例,术后伤口浅表感染1例。两组患者均未出现神经损伤并发症。 结论：显微内镜辅助经皮微创TLIF较传统开放手术具有创伤小、出血少、恢复快、住院时间短等优点,具有良好的近期疗效,是治疗腰椎失稳症值得推荐的微创手术方式。     

微创经椎间孔腰椎间融合术治疗腰椎退变性疾病

目的探讨微创经椎间孔腰椎间融合术(MIS-TLIF)治疗腰椎退变性疾病的可行性和早期疗效。方法采用MIS-TLIF治疗30例腰椎退变性疾病患者,其中Ⅰ~Ⅱ度退行性或峡部裂型腰椎滑脱症12例,退行性腰椎管狭窄伴节段性不稳8例,腰椎间盘突出症10例。均为单节段融合。结果手术时间127~209(168±41)min;术中出血量23~361(192±169)ml;术中X线照射时间72~136(104±32)s;术后首次下床活动时间1.4~3.8(2.6±1.2)d。疼痛VAS评分术前(7.20±1.02)分,末次随访(1.71±0.66)分,差异有统计学意义(P0.01)。末次随访椎间融合率为100%。未发生并发症。X线片显示cage无移位、松动、下沉,椎弓根钉无松动、折断。结论 MIS-TLIF对腰椎的解剖结构破坏小,对椎旁肌肉的剥离少,患者术后恢复快,是一种有效、安全、损伤较小的手术方法,可用于腰椎不稳、局限节段椎间盘病变、≤Ⅱ度以下腰椎滑脱的患者;但手术时间较长,医患X线暴露较多。     

MIS-TLIF术和TLIF术治疗单节段腰椎管狭窄症效果对比

目的 研究比较微创经椎间孔入路腰椎椎间融合术（MIS-TLIF）与经椎间孔腰椎椎间融合术（TLIF）治疗单节段腰椎管狭窄症的临床疗效。方法 使用便利抽样法选取我院2016年1月~2020年12月收治的单节段腰椎管狭窄症患者60例作为研究对象,根据接受的手术方法将患者分为对照法将其分为MIS-TLIF组（n=30例）和TLIF组（n=30例）。比较两组患者围手术期相关指标差异、术前与术后不同时间腰椎Oswestry功能障碍指数（ODI）及视觉模拟评分法（VAS）评分差异,采血测定手术前后血清白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肌酸激酶（CK）及C反应蛋白（CRP）等实验室指标变化。结果 研究组患者手术持续时间长于对照组（P<0.05）,术中出血量、术后引流量、术后下床时间及出院时间均小于对照组（P<0.05）;术后不同时间研究组患者ODI评分均低于对照组（P<0.05）;术后不同时间研究组患者VAS评分均低于对照组（P<0.05）;治疗后研究组患者血清IL-6、IL-10、CK及CRP表达水平低于对照组（P<0.05）。结论 MIS-TLIF术在治疗单节段腰椎管狭窄症患者中应用安全性更高,缩短患者术后恢复时间并改善其腰椎功能及疼痛症状,减轻术后肌肉损伤程度,促进患者炎症指标恢复。     

斜外侧椎间融合术与微创经椎间孔入路腰椎椎间融合术治疗单节段轻中度腰椎滑脱的临床疗效

目的 比较斜外侧椎间融合术（OLIF）与微创经椎间孔入路腰椎椎间融合术（MIS-TLIF）治疗单节段轻中度腰椎滑脱的临床疗效和影像学结果。方法 2015年2月—2018年2月,收治单节段轻中度腰椎滑脱患者48例,其中22例采用OLIF治疗（OLIF组）,26例采用MIS-TLIF治疗（MIS-TLIF组）。记录2组手术时间、术中出血量、住院时间及并发症发生情况;术前及术后1周、1个月、6个月及末次随访时采用疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评估腰腿痛程度及腰椎功能。术前及末次随访时在影像学资料上测量腰椎前凸角（LL）、手术节段Cobb角、椎间高度（DH）、椎管横截面积（CSA）及椎间孔面积（FA）。结果 所有手术顺利完成,所有患者随访24～45个月,平均32.8个月。OLIF组手术时间、术中出血量及住院时间明显少于MIS-TLIF组,差异均有统计学意义（P <0.05）。2组术后各随访时间点VAS评分和ODI较术前明显改善,差异均有统计学意义（P <0.05）;术后1周OLIF组VAS评分和ODI优于MIS-TLIF组,差异均有统计学意义...     

DELTA内镜下单侧入路双侧减压治疗腰椎椎管狭窄症的疗效分析

目的 探讨DELTA内镜下单侧入路双侧减压治疗单节段腰椎管狭窄症的临床疗效.方法 选取广东省中医院骨科自2018年1月～2019年6月手术治疗的60例单节段腰椎管狭窄症患者,根据手术方式不同分为DELTA组和MIS-TLIF组,DELTA组采用DELTA内镜下单侧椎板间入路双侧减压术治疗,MIS-TLIF组采用微创管道...     

Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis

Background ContextMinimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) was developed in addition to open-TLIF to minimize iatrogenic soft-tissue damage. A potential disadvantage of MIS-TLIF is inadequate visualization, which may lead to incomplete neural decompression and a less robust arthrodesis. This may cause long-term problems and result in decreased patient satisfaction.PurposeTo evaluate the long-term clinical outcome, measured by patient-reported outcomes (PROMs), of patients with degenerative lumbar diseases treated with single-level TLIF (open vs. minimally invasive) with a minimum follow-up of 2-years.Study DesignMeta-analysis.MethodsThe systematic review was conducted according to the PRISMA guidelines. Relevant studies were identified from Pubmed, MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL from the date of inception to August 2019. The inclusion criteria were (1) longitudinal comparative studies of MIS-TLIF versus open-TLIF approach for degenerative spine disease (2) outcomes reported as PROMs, (3) minimum follow-up of 2-years.ResultsSixteen studies were included in the analysis. In total, 1,321 patients were included (660 MIS-TLIF& 661 open-TLIF). The following PROMS were analyzed: EQ-5D, SF, ODI, and VAS. Both techniques resulted in significant improvement in PROM, which remained significant at 2-years follow-up. However, no significant differences were found in all PROMs at 2-years follow-up. Both treatments resulted in a high rate of spinal fusion (80.5% vs. 91.1%; p=.29) and low rate of reoperation (3.0% vs. 2.4%; p=.50) or adjacent segment disease (12.6% vs. 12.40%; p=.50).ConclusionsMIS-TLIF and open-TLIF have comparable long-term clinical outscomes. Both operations can significantly reduce pain and positively improve PROMs. No significant differences were found between both treatments in clinical outcomes at a follow-up of minimal 2-years. Therefore, MIS-TLIF seems to be an effective and safe alternative to traditional open-TLIF in the long-term.     

微创经椎间孔入路与极外侧入路腰椎椎间融合术治疗短节段腰椎退行性疾病的近期疗效比较

目的比较微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与极外侧入路腰椎椎间融合术(XLIF)治疗退行性腰椎滑脱合并腰椎椎管狭窄的近期疗效。方法回顾性分析2013年3月—2014年6月收治的75例腰椎退行性疾病且行微创手术治疗患者的临床资料,其中36例选择行MIS-TLIF,39例选择行XLIF。记录2组患者手术时间、术中出血量,分析随访2年期间患者下肢痛和腰痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、生活质量评价量表(SF-36)评分和患者对手术的满意度。结果 MIS-TLIF组和XLIF组中位手术时间分别为169 min和182 min,差异无统计学意义(P 0.05);MIS-TLIF组术中出血量为(90±20)mL,XLIF组术中出血量为(50±10)mL,差异有统计学意义(P 0.05)。随访2年,所有患者下肢痛和腰痛VAS评分、ODI和SF-36评分均较术前明显改善,差异有统计学意义(P 0.05),但组间比较差异均无统计学意义(P 0.05)。结论 MIS-TLIF与XLIF虽然减压机制不同,但随访2年的术后疗效无明显差异,2种微创方法均可有效治疗腰椎退行性疾病。     

微创经椎间孔椎间融合术联合单、双侧内固定治疗单间隙腰椎退变性疾病

 目的 探讨微创经椎间孔椎间融合术（minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF）联合单侧或双侧内固定治疗单节段腰椎退行性疾病的临床及影像学疗效。方法 回顾性分析 2009年 10月至 2011年 12月期间,采用 METRx-MD（Microscopic Endoscopic Tubular Retractor System）进行 MIS-TLIF治疗单节段腰椎退行性疾病并获得长期随访的 65例患者的相关资料。根据内固定方式分为两组,单侧固定组（31例）采用 MIS-TLIF联合单侧内固定技术,双侧组（34例）采用 MIS-TLIF联合双侧经皮内固定技术。采用 Oswestry功能障碍指数（Oswestry disability index,ODI）评价腰椎功能情况,采用疼痛视觉模拟评分（visual analogue scale,VAS）分别对腰痛及下肢痛进行评估;在 X线片上测量手术前后的腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度,计算腰椎前凸指数及椎间高度指数。结果 所有患者均顺利完成手术,术后随访 18~36个月,平均 26.6个月。所有患者术后 12个月均获得骨性融合。两组患者术后 VAS及 ODI评分均较术前有明显改善,两组间术前及随访期间 VAS及 ODI评分的差异无统计学意义。影像学测量结果显示两组间腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度、腰椎前凸指数及椎间高度指数的差异均无统计学意义,腰椎前凸角度与腰椎前凸指数呈线性相关。结论 对于治疗单间隙腰椎退变性疾病,MIS-TLIF联合单侧或双侧经皮内固定技术具有相似的临床及影像学疗效。     

经多裂肌与竖脊肌间隙入路行微创经椎间孔腰椎间融合术的前瞻性研究

目的探讨经多裂肌与竖脊肌间隙入路行微创经椎间孔腰椎间融合术（MIS-TLIF）治疗腰椎间盘退变性疾病的疗效。方法前瞻性分析2010年4月至2010年10月中山大学附属孙逸仙纪念医院收治的62例腰椎间盘退变性疾病患者的临床资料,采用随机数字表法将患者分为TLIF组（采用后路正中入路TLIF术,30例）和MIS-TLIF组（采用经多裂肌与竖脊肌间隙入路行MIS-TLIF,32例）,比较两组患者的一般资料、围手术期情况、视觉模拟评分（VAS）及多裂肌MRI信号的改变。结果 TLIF组、MIS-TLIF组平均手术时间分别为（110 ±20）、（100 ± 35）min/节段（P 〉0.05）;术中平均出血量分别为（420 ± 110）、（300 ± 40）mL（P 〈0.05）;术后平均引流量分别为（360 ± 120）、（40 ± 20）mL/节段（P 〈0.05）。两组患者术后3、6个月VAS分别与术前比较,差异有统计学意义（P 〈0.05）;对术后3个月VAS进行组间比较,差异有统计学意义（P 〈0.05）。TLIF组患者手术前后多裂肌 MRI 信号分别为（1.5 ± 0.4）级、（2.5 ± 0.5）级,两者比较,差异有统计学意义（P 〈0.05）;MIS-TLIF 组患者手术前后多裂肌 MRI 信号分别为（1.5 ± 0.5）级、（1.6 ± 0.5）级,两者比较,差异无统计学意义（P 〉0.05）。结论 MIS-TLIF可减少脊柱后部肌肉损伤,加速腰痛的恢复,近期效果较好。     

微创腰椎经椎间孔椎体间融合术的并发症分析：131例病例回顾和文献复习

背景：微创腰椎经椎间孔入路椎间融合（MIS-TLIF）被广泛应用于腰椎退变的手术治疗并取得了良好的临床效果,但微创手术可能增加并发症的风险。 目的：总结MIS-TLIF的发生,并探讨并发症的发生原因和相关对策。 方法：对2010年1月至2011年5月间行MIS-TLIF手术的连续131例病例进行回顾分析。记录患者的手术时间,术中出血量,术后住院时间,并发症情况。并在术前、术后3个月以及末次随访时以VAS评分评估患者手术前后腰痛的程度,以Oswestry伤残指数和JOA评分评估患者的功能。 结果：平均随访8．3个月;所有患者平均手术时间为（146．4±36．9）min,平均术中出血（176．7±86．1）ml,术后平均住院时间为（4．4±1．6）d;患者术后3个月及最后随访时腰痛及功能状况均较术前有明显的改善;16人次（12．2％）出现并发症：伤口局部血肿1例（0．8％）;硬膜撕裂6例（4．6％）;椎弓根螺钉位置欠佳6枚（1．0％）;1例不明原因足下垂（0．8％）;1例79岁患者术后出现肺部感染（0．8％）;1例76岁患者术后出现尿潴留（0．8％）。 结论：微创腰椎经椎间孔椎体问融合术治疗腰椎退变性疾病安全、可靠,并发症的发生主要与MIS-TLIF的手术特点、学习曲线及患者的选择有关,应重视MIS-TLIF手术技术的培训,严格掌握适应证,以减少相关并发症的发生。只要进行严格的筛选和术前准备,老年患者也可进行微创手术的治疗。     

微创经椎间孔入路腰椎椎间融合术治疗腰椎滑脱症的中短期随访

目的对比微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与传统开放后路腰椎椎间融合术(PLIF)治疗单节段腰椎滑脱症的中短期疗效,以评价MIS-TLIF的安全性。方法回顾性分析2015年3月—2017年9月166例单节段腰椎滑脱症患者临床资料,70例行MIS-TLIF治疗,96例行PLIF治疗。比较2组患者围手术期指标、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)与术后并发症发生情况。结果 MIS-TLIF组术中出血量、术后引流量、切口长度、术后卧床天数、术后住院天数、住院费用和手术满意度均优于PLIF组,差异有统计学意义(P 0.05);但MIS-TLIF组术后血清肌酸激酶值显著高于PLIF组,差异有统计学意义(P 0.05);2组手术时间,手术前后VAS评分、ODI,并发症发生率和椎间融合率差异均无统计学意义(P 0.05)。结论 MIS-TLIF治疗腰椎滑脱症,疗效确切,安全性好,术后恢复快,住院费用低,手术满意度高;但MIS-TLIF术后血清肌酸激酶值偏高,考虑可能因术中使用电刀,通道空间狭小,术中吸引器使用少,肌酸激酶大量吸收入血所致,仍需进一步研究证实。     

Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique

BACKGROUND CONTEXTMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with microscopic tubular technique is an established surgical procedure with several potential advantages, including decreased surgical-related morbidity, reduced length of hospital stay, and accelerated early rehabilitation. A recently introduced biportal endoscopic technique for spine surgery presents familiar surgical anatomy and can be conducted using a conventional approach with a minimal footprint; it is also applicable to TLIF.PURPOSETo compare the clinical and radiological outcomes of biportal endoscopic technique transforaminal lumbar interbody fusion (BE-TLIF) and microscopic tubular technique transforaminal lumbar interbody (MT-TLIF) in patients with single- or two-segment lumbar spinal stenosis with or without spondylolisthesis.STUDY DESIGNA retrospective cohort study.PATIENT SAMPLEOne hundred two participants with neurogenic intermittent claudication or lumbar radiculopathy with single- or two-level lumbar spinal stenosis with or without spondylolisthesis.OUTCOME MEASURESClinical outcomes were assessed using the visual analog scale (VAS) score for the back and leg pain, Oswestry Disability Index (ODI), and the Short Form-36 health survey Questionnaire (SF-36). Demographic data, operative data (total operation time, estimated blood loss, amount of surgical drain, postoperative transfusion, and length of hospital stay), and laboratory results (plasma hemoglobin, serum creatine phosphokinase, and C-reactive protein) were also evaluated. The fusion rate was assessed using the Bridwell interbody fusion grading system. Postoperative complications were also noted.METHODSPatients were divided into two groups: group A (BE-TLIF) and group B (MT-TLIF). The clinical outcomes, including VAS-Back and VAS-Leg, ODI, and SF-36 scores, were evaluated at 1 month, 6 months, and 1 year after surgery. Differences in demographics, operative data, and the laboratory and radiological results were assessed between the two groups. The fusion rate was assessed using standard standing lumbar radiographs and computed tomography scans conducted 1 year after surgery.RESULTSSeventy-nine patients were analyzed in this study, 47 from group A and 32 from group B. Demographic and operative data were comparable for both the groups. The VAS-Back and SF-36 scores were more significantly improved in group A than in group B at 1 month after surgery. However, there were no significant differences between groups for the mean VAS-Back, VAS-Leg, ODI, and SF-36 scores at 1year after the surgery. Although the total operation time was significantly longer in group A, the estimated blood loss and the amount of surgical drainage was significantly higher in group B (p < .001). There were no between-group differences for the fusion rate and postoperative complications.CONCLUSIONBoth BE-TLIF and MT-TLIF provided equivalent and favorable clinical outcomes and fusion rates. Further large-scale, randomized, controlled trials with long-term follow-ups are warranted.     

管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病

目的 探讨管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的临床疗效.方法 2013年11月—2016年2月,同济大学附属同济医院采用管状通道下单侧入路双侧减压MIS-TLIF治疗28例单节段腰椎退行性疾病患者.记录手术时间、术中出血量、术后引流量;测量手术前后及末次...     

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

Background

Hidden haemorrhage has been proved to be significant in joint surgery. However, when referring to lumbar interbody fusion, it is often ignored because of its invisibility. This randomized controlled study aimed to calculate and compare hidden haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion (MIS-TLIF and open TLIF). Meanwhile, its clinical significance was also analyzed.

Materials and methods

A total of 41 patients were included in this study, then they were randomized to receive MIS-TLIF or open TLIF, 21 and 20, respectively. For each case, total volume loss of red blood cell (RBC) was calculated by Gross' formula based on perioperative haematocrit change, then perioperative visible volume loss of RBC was calculated through haemorrhage volume and weight. After deducting it from total volume loss of RBC, hidden volume loss of RBC was obtained. Absolute amount of hidden haemorrhage and its ratio upon total haemorrhage, as well as indicators assessing clinical outcomes, including visual analogue scale (VAS) for back and leg, Oswestry disability index (ODI), interbody fusion rate and complication incidence were compared and analyzed.

Results

Mean hidden volume loss of RBC in MIS-TLIF was significantly reduced compared with open TLIF (166.7 versus 245.6 ml). Besides, both mean total and visible volume loss of RBC in MIS-TLIF were also statistically less than those in open TLIF (355.3 versus 538.6 ml; 188.6 versus 293.0 ml). While mean ratio of hidden haemorrhage upon total haemorrhage was 46.7% for MIS-TLIF and 44.5% for open TLIF, respectively, showing no statistical significance. At one week postoperatively, more significant improvements of VAS for back and leg, as well as ODI were seen in MIS-TLIF compared with open TLIF. While at final follow-up of at least 2 years, all parameters continued to improve and revealed no statistical difference between both surgeries. Similar interbody fusion rate and complication incidence were observed in both series.

Conclusions

Besides reduced visible haemorrhage and improved clinical outcomes, MIS-TLIF also owns the superiority of less hidden haemorrhage, offering another advantage over open TLIF.

Level of evidence

Level II.

     

Outcomes following transpsoas lateral lumbar interbody fusion

The transpsoas lateral lumbar interbody fusion (LLIF) is utilized to treat multiple spinal conditions ranging from degenerative disorders to spinal deformities. The transpsoas LLIF was developed to limit the vascular complications of the anterior lumbar approach and minimize extensive soft tissue dissection and neural manipulation of the posterior approach. Compared to other fusion techniques, the transpsoas LLIF has demonstrated more favorable clinical outcomes (lower VAS and ODI scores), a greater improvement in radiological outcomes, lower risk of bleeding, shorter operative times, and higher fusion rates. It is a cost-effective technique that is associated with a shorter length of stay, lower reoperation/readmission rates, and minimal risk of complications. This review provides an overview of transpsoas LLIF and highlights the surgical outcomes, including operative and postoperative complications associated with this surgical technique.     

Influence of contoured versus straight rod on clinical outcomes and sagittal parameters in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at L4/5 level-more than 5 years follow-up

BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is among the most commonly performed surgical procedure to treat lumbar degenerative disorders. In open TLIF procedure, usually rods were contoured to restore normal lumbar sagittal alignment. However, in MIS-TLIF procedure, contoured rods sometimes were easier to rotate and harder to be locked at the satisfactory position due to instrumentation design and limited exposure. Thus, straight rods had been used in single-level MIS-TLIF in our institution. However, the effect of rod contouring on sagittal parameters and clinical outcomes remains unclear. In the present study, we aim to evaluate the effects of single-segment MIS-TLIF with contoured versus straight rods on sagittal parameters and clinical outcomes.MethodsA retrospective review of MIS-TLIF at L4/5 was performed between 2009 and 2013 in our hospital. Seventy-six cases were divided into contoured rod group (CR group, n = 35) and straight rod group (SR group, n = 41). Clinical outcomes and radiographic measurements at five years’ follow-up were evaluated by visual analog score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) score, spino-pelvic parameters, disc height and fused segment angle. Fusion rate and cage subsidence were also measured.ResultsPreoperative VAS, JOA, ODI and radiographic parameters were comparable between two groups. The average follow-up was 63.72 ± 3.86 months. VAS, JOA and ODI were significantly improved at 5-year follow-up in both groups, and there were no significant differences between two groups(P > 0.05). Fused segment angle (FSA) was greater in CR group than SR group (P = 0.024), while the other radiographic parameters were not significantly different(P > 0.05). Rod process, fusion rate and cage subsidence were not risk factors of post-surgical malalignment, patients with pre-surgical sagittal imbalance was more prone to show post-surgical malalignment (P < 0.05).ConclusionsBoth CR and SR groups acquired satisfactory clinical results. Although contoured rods had better fused segment angle, contoured or straight rods at single L4/5 level had little effect on global spino-pelvic parameters and clinical outcomes in a 5-year follow-up.     

显微镜辅助下微创与开放经椎间孔腰椎间融合术治疗单节段腰椎退行性疾病的疗效比较

背景:微创经椎间孔腰椎椎体间融合术(MIS-TLIF)与开放经椎间孔腰椎间融合术(TLIF)是目前临床上治疗单节段腰椎退行性疾病的两种主要方法。如何既有效减压、可靠融合及固定,又能减少损伤及并发症的发生是临床追求的目标。目的:比较显微镜辅助下MIS-TLIF与TLIF治疗单节段腰椎退行性疾病的临床疗效。方法:回顾性分析2015年8月至2016年10月收治的单节段腰椎退行性疾病患者60例。其中32例采用显微镜辅助下MIS-TLIF治疗(MIS-TLIF组),28例采用TLIF治疗(TLIF组)。记录并比较两组患者手术时间、术中失血量、术后引流量和住院时间,并观察术后并发症发生情况。术前,术后3 d,术后3、12、36个月记录两组患者疼痛视觉模拟评分(VAS)、日本骨科协会评估治疗评分(JOA)及Oswestry功能障碍指数(ODI),并进行比较。末次随访时根据MacNab标准评价疗效。术后3个月及末次随访时采用Suk标准评价腰椎融合情况。结果:两组患者均顺利完成手术,未出现硬膜破裂、神经根损伤、切口感染、融合器移位、下沉、内固定松动等并发症。所有患者均获得随访,随访时间36~42个月,平均随访(38.3±1.4)个月。与TLIF组患者相比,MIS-TLIF组患者手术时间更长,术中出血量、术后引流量均更少,住院时间更短,且差异均有统计学意义(P<0.001)。MIS-TLIF组、TLIF组患者术后各时间点腰痛及腿痛VAS评分、ODI指数均低于,JOA评分均高于术前,且差异均有统计学意义(P<0.001)。术后3 d MIS-TLIF组患者腰痛及腿痛VAS评分、ODI指数均低于,JOA评分高于开放TLIF组患者,且差异均有统计学意义(P<0.05);而术后3、12、36个月,两组患者疼痛VAS评分、JOA评分及ODI指数差异均无统计学意义。末次随访时两组患者优良率及椎间融合情况差异均无统计学意义。结论:与TLIF相比,显微镜辅助下MIS-TLIF具有术中出血少、创伤小、术后康复快、临床疗效确切等优势。