Abstract：
OBJECTIVE: The operative microscope (OM) has revolutionized the field of modern spine surgery, however, it remains limited by several drawbacks. Recently, the exoscope (EX) system has been designed to assistant spine surgery. It provides a three-dimensional (3D) high-definition (HD) operative experience and becomes an alternative to the OM. The aim of the study was to evaluate the clinical outcomes, advantages and limitations of EX-assisted minimally invasive transforaminal lumbar interbody fusion (EMIS-TLIF) and OM-assisted MIS-TLIF (OMIS-TLIF).
METHODS: The clinical outcomes were assessed in 47 patients with lumbar degenerative diseases (LDD) who underwent MIS-TLIF assisted with the OM or EX between January 2019 and September 2020. A total of 22 were treated with EMIS-TLIF, and 25 received OMIS-TLIF. Perioperative parameters (including sex, age, number of fusion levels and body mass index), perioperative parameters (operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization stay, and duration of follow-up), visual analogue scale (VAS) of back pain, VAS of leg pain, Oswestry disability index (ODI) scores and clinical outcomes were assessed and compared. Image quality, handling of equipment, ergonomics, 3D glasses and educational usefulness were scored according to a questionnaire.
RESULTS: Operation time in the OMIS-TLIF group (121.92 ± 16.92 min) was significantly increased compared with that in the EMIS-TLIF group (111.00 ± 19.87 min) (P < 0.05). The VAS of the back pain and ODI scores in the EMIS-TLIF group were significantly lower compared with the OMIS-TLIF group at 1 week postoperatively (P < 0.05). The good-excellent outcomes rate was 90.91% in the EMIS-TLIF group and 88.00% in the OMIS-TLIF group, and there was no significant difference. A total of 44 visits completed the questionnaire. The results of the questionnaire showed that the EX has exhibited advantages regarding handing of equipment, ergonomics and educational usefulness, and comparable image quality as compared with the OM, however, operating surgeons complained uncomfortable sensation when wearing 3D glasses.
CONCLUSIONS: The EMIS-TLIF was a safe and effective procedure in the management of LDD as compared with the OMIS-LIF. Meanwhile, EMIS-TLIF might resulted in a short operation time.
METHODS: The clinical outcomes were assessed in 47 patients with lumbar degenerative diseases (LDD) who underwent MIS-TLIF assisted with the OM or EX between January 2019 and September 2020. A total of 22 were treated with EMIS-TLIF, and 25 received OMIS-TLIF. Perioperative parameters (including sex, age, number of fusion levels and body mass index), perioperative parameters (operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization stay, and duration of follow-up), visual analogue scale (VAS) of back pain, VAS of leg pain, Oswestry disability index (ODI) scores and clinical outcomes were assessed and compared. Image quality, handling of equipment, ergonomics, 3D glasses and educational usefulness were scored according to a questionnaire.
RESULTS: Operation time in the OMIS-TLIF group (121.92 ± 16.92 min) was significantly increased compared with that in the EMIS-TLIF group (111.00 ± 19.87 min) (P < 0.05). The VAS of the back pain and ODI scores in the EMIS-TLIF group were significantly lower compared with the OMIS-TLIF group at 1 week postoperatively (P < 0.05). The good-excellent outcomes rate was 90.91% in the EMIS-TLIF group and 88.00% in the OMIS-TLIF group, and there was no significant difference. A total of 44 visits completed the questionnaire. The results of the questionnaire showed that the EX has exhibited advantages regarding handing of equipment, ergonomics and educational usefulness, and comparable image quality as compared with the OM, however, operating surgeons complained uncomfortable sensation when wearing 3D glasses.
CONCLUSIONS: The EMIS-TLIF was a safe and effective procedure in the management of LDD as compared with the OMIS-LIF. Meanwhile, EMIS-TLIF might resulted in a short operation time.
摘要：
目的：手术显微镜（OM）彻底改变了现代脊柱外科领域，然而,它仍然受到几个缺点的限制。最近,外镜（EX）系统已被设计为辅助脊柱手术。它提供了三维（3D）高清（HD）操作体验，并成为OM的替代品。这项研究的目的是评估临床结果，EX辅助微创经椎间孔腰椎椎间融合术(EMIS-TLIF)和OM辅助MIS-TLIF(OMIS-TLIF)的优势和局限性。
方法：在2019年1月至2020年9月期间，在OM或EX辅助下接受MIS-TLIF的47例腰椎退行性疾病（LDD）患者的临床结果进行了评估。共有22例患者接受EMIS-TLIF治疗,25人接受了OMIS-TLIF。围手术期参数（包括性别，年龄,融合水平数和体重指数)，围手术期参数(手术时间，术中失血,术后引流,术后住院时间,和随访持续时间)，背痛的视觉模拟量表（VAS），腿部疼痛的VAS，评估并比较Oswestry残疾指数（ODI）评分和临床结局。图像质量,处理设备，人体工程学,根据问卷对3D眼镜和教育实用性进行评分。
结果：OMIS-TLIF组手术时间(121.92±16.92min)较EMIS-TLIF组(111.00±19.87min)明显延长(P<0.05)。术后1周,EMIS-TLIF组腰痛VAS评分和ODI评分均低于OMIS-TLIF组(P<0.05)。EMIS-TLIF组的优良率为90.91%，OMIS-TLIF组的优良率为88.00%。并无显著差异。共有44次访问完成了问卷。问卷的结果表明，EX在处理设备方面表现出优势，人体工程学和教育实用性，与OM相比，图像质量相当，然而,外科医生抱怨戴3D眼镜时感觉不舒服。
结论：与OMIS-LIF相比，EMIS-TLIF是一种安全有效的LDD治疗方法。同时,EMIS-TLIF可能导致较短的手术时间。
方法：在2019年1月至2020年9月期间，在OM或EX辅助下接受MIS-TLIF的47例腰椎退行性疾病（LDD）患者的临床结果进行了评估。共有22例患者接受EMIS-TLIF治疗,25人接受了OMIS-TLIF。围手术期参数（包括性别，年龄,融合水平数和体重指数)，围手术期参数(手术时间，术中失血,术后引流,术后住院时间,和随访持续时间)，背痛的视觉模拟量表（VAS），腿部疼痛的VAS，评估并比较Oswestry残疾指数（ODI）评分和临床结局。图像质量,处理设备，人体工程学,根据问卷对3D眼镜和教育实用性进行评分。
结果：OMIS-TLIF组手术时间(121.92±16.92min)较EMIS-TLIF组(111.00±19.87min)明显延长(P<0.05)。术后1周,EMIS-TLIF组腰痛VAS评分和ODI评分均低于OMIS-TLIF组(P<0.05)。EMIS-TLIF组的优良率为90.91%，OMIS-TLIF组的优良率为88.00%。并无显著差异。共有44次访问完成了问卷。问卷的结果表明，EX在处理设备方面表现出优势，人体工程学和教育实用性，与OM相比，图像质量相当，然而,外科医生抱怨戴3D眼镜时感觉不舒服。
结论：与OMIS-LIF相比，EMIS-TLIF是一种安全有效的LDD治疗方法。同时,EMIS-TLIF可能导致较短的手术时间。
