PDF(Pubmed)
Abstract：
Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: \"(laparoscopic OR endoscopic) AND (anterior AND lumbar).\" Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio\'s \"metafor\" package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.
摘要：
腹腔镜腰椎前路椎间融合术(L-ALIF),它采用腹腔镜摄像机来促进一种侵入性较小的方法，最初在20世纪90年代获得了牵引力，但后来失宠了。随着内窥镜入路的封套不断被推动，腹腔镜和/或内窥镜前路手术可能会复发.因此,评估当前有关该方法的证据基础具有很大的临床意义.为此,根据PRISMA(系统评价和荟萃分析的首选报告项目)指南,使用以下关键词进行系统文献检索:\"(腹腔镜或内窥镜)和(前路和腰椎).\"在检索到的441篇文章中，选择22例进行定量分析。感兴趣的主要结果是射线照相融合率。次要结果是围手术期并发症的发生率。使用RStudio的“metafor”软件包进行Meta分析。在1,079名患者中(平均年龄，41.8±2.9年)，481人为男性（44.6%）。L-ALIF手术最常见的适应症是退行性椎间盘疾病（18项研究报告，81.8%）。平均随访时间为18.8±11.2个月(范围，6-43个月）。合并融合率为78.9%(95%置信区间[CI]，68.9-90.4).并发症发生率为19.2%（95%CI，13.4～27.4）。此外,7.2％（95％CI，4.6-11.4）的患者需要从L-ALIF转换为开放手术。虽然L-ALIF似乎没有文献中的研究支持，重要的是要考虑获得这些结果的背景。即使这些结果是按面值计算的，内窥镜检查不能在ALIF入路中发挥作用并不意味着它不应该被纳入后路入路.
