Abstract：
BACKGROUND: The aim of this study was to determine the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) compared to modified open TLIF via the Wiltse approach for treatment of degenerative diseases of the lumbosacral region. The results were evaluated over a post-operative period of 48 months.
METHODS: Radiological data and medical records of patients who underwent MIS TLIF and modified open TLIF between May 2017 and May 2021 were reviewed. Parameters monitored to evaluate the surgical results were: clinical status, operation time, blood loss, radiation dose to patient, day of discharge, analgesic consumption, fusion, and complications rate. For functional assessment, the Visual Analogue Scale for back pain (VAS-BP), VAS for leg pain (VAS-LP), Oswestry Disability Index (ODI), Patient Satisfaction Rate (PSR), and the complication rate were used.
RESULTS: This study included 57 patients randomly divided into two groups: 30 operated on using the MIS TLIF technique, and 27 operated on using the modified open TLIF technique via the Wiltse approach. 48-month follow-up rates were similar for the two cohorts. Patients did not differ significantly at baseline in terms of ODI, VAS-BP, or VAS-LP. Perioperatively, MIS TLIF was associated with significantly less blood loss (167.3 ± 80.0 vs. 297.9 ± 81.5 ml, p = 1.1E-05), slightly longer procedures (185.7 ± 45.2 vs. 183.1 ± 66.4 minutes, p = 0.76), a lower radiation dose (MIS 16.9 ± 7.1 vs. 22.0 ± 9.7 mGy OPEN p = 0.012), and shorter hospitalisations (MIS 5.9 ± 1.8 vs. 7.7 ± 1.6 days OPEN). The most common complication was radiculitis, which accounted for 33% and 37% in the MIS and the TLIF groups, respectively. The second most common complication was malposition of the fixation material, which accounted for 18.5% in the TLIF group and 20% in the MIS group. The level of fusion achieved was 92.6% in the MIS group versus 92.3% in the TLIF group. There was lower consumption of analgesics in MIS. Patient Satisfaction Rate (PSR) was 90%.
CONCLUSIONS: Clinical and radiological outcomes after MIS TLIF in patients with degenerative disease of the lumbosacral region are generally favourable. MIS TLIF was associated with decreased blood loss perioperatively, a lower radiation dose and an earlier discharge, but there was no difference between MIS TLIF and modified open TLIF in 48-month outcomes in terms of disability, back pain, leg pain, quality of life, or patient satisfaction rate or complication rate. Although the differences taper off over time, MIS TLIF has undeniable advantages in the perioperative and early postoperative periods.
METHODS: Radiological data and medical records of patients who underwent MIS TLIF and modified open TLIF between May 2017 and May 2021 were reviewed. Parameters monitored to evaluate the surgical results were: clinical status, operation time, blood loss, radiation dose to patient, day of discharge, analgesic consumption, fusion, and complications rate. For functional assessment, the Visual Analogue Scale for back pain (VAS-BP), VAS for leg pain (VAS-LP), Oswestry Disability Index (ODI), Patient Satisfaction Rate (PSR), and the complication rate were used.
RESULTS: This study included 57 patients randomly divided into two groups: 30 operated on using the MIS TLIF technique, and 27 operated on using the modified open TLIF technique via the Wiltse approach. 48-month follow-up rates were similar for the two cohorts. Patients did not differ significantly at baseline in terms of ODI, VAS-BP, or VAS-LP. Perioperatively, MIS TLIF was associated with significantly less blood loss (167.3 ± 80.0 vs. 297.9 ± 81.5 ml, p = 1.1E-05), slightly longer procedures (185.7 ± 45.2 vs. 183.1 ± 66.4 minutes, p = 0.76), a lower radiation dose (MIS 16.9 ± 7.1 vs. 22.0 ± 9.7 mGy OPEN p = 0.012), and shorter hospitalisations (MIS 5.9 ± 1.8 vs. 7.7 ± 1.6 days OPEN). The most common complication was radiculitis, which accounted for 33% and 37% in the MIS and the TLIF groups, respectively. The second most common complication was malposition of the fixation material, which accounted for 18.5% in the TLIF group and 20% in the MIS group. The level of fusion achieved was 92.6% in the MIS group versus 92.3% in the TLIF group. There was lower consumption of analgesics in MIS. Patient Satisfaction Rate (PSR) was 90%.
CONCLUSIONS: Clinical and radiological outcomes after MIS TLIF in patients with degenerative disease of the lumbosacral region are generally favourable. MIS TLIF was associated with decreased blood loss perioperatively, a lower radiation dose and an earlier discharge, but there was no difference between MIS TLIF and modified open TLIF in 48-month outcomes in terms of disability, back pain, leg pain, quality of life, or patient satisfaction rate or complication rate. Although the differences taper off over time, MIS TLIF has undeniable advantages in the perioperative and early postoperative periods.
摘要：
背景：本研究的目的是确定微创经椎间孔腰椎椎间融合术（MISTLIF）与经Wiltse入路改良开放TLIF治疗腰骶区退行性疾病的临床和放射学结果。术后48个月对结果进行评估。
方法：回顾了2017年5月至2021年5月接受MISTLIF和改良开放TLIF的患者的放射学数据和医疗记录。监测以评估手术结果的参数是：临床状态，操作时间,失血,对患者的辐射剂量，出院日,镇痛消耗，聚变,和并发症发生率。对于功能评估，背痛视觉模拟评分（VAS-BP），腿部疼痛的VAS（VAS-LP），Oswestry残疾指数（ODI），患者满意度（PSR）和并发症发生率。
结果：本研究包括57例患者，随机分为两组：30例采用MISTLIF技术进行手术，和27通过Wiltse方法使用改进的开放TLIF技术进行操作。两组48个月的随访率相似。患者在基线ODI方面没有显著差异，VAS-BP,或VAS-LP。围手术期,MISTLIF与明显减少失血相关（167.3±80.0vs.297.9±81.5ml,p=1.1E-05)，稍长的程序（185.7±45.2vs.183.1±66.4分钟，p=0.76),较低的辐射剂量(MIS16.9±7.1vs.22.0±9.7mGyOPENp=0.012)，住院时间较短(MIS5.9±1.8vs.7.7±1.6天开放)。最常见的并发症是神经根炎，在MIS和TLIF组中分别占33%和37%，分别。第二个最常见的并发症是固定材料错位，TLIF组占18.5%,MIS组占20%。MIS组达到的融合水平为92.6％，而TLIF组为92.3％。MIS中镇痛药的消耗量较低。患者满意度（PSR）为90%。
结论：腰骶部退行性疾病患者MISTLIF后的临床和放射学结果通常是有利的。MISTLIF与围手术期失血减少有关，较低的辐射剂量和较早的放电，但是MISTLIF和改良开放TLIF在48个月的残疾方面没有差异，背痛,腿部疼痛,生活质量,或患者满意度或并发症发生率。尽管随着时间的推移差异逐渐减少，MISTLIF在围手术期和术后早期具有不可否认的优势。
方法：回顾了2017年5月至2021年5月接受MISTLIF和改良开放TLIF的患者的放射学数据和医疗记录。监测以评估手术结果的参数是：临床状态，操作时间,失血,对患者的辐射剂量，出院日,镇痛消耗，聚变,和并发症发生率。对于功能评估，背痛视觉模拟评分（VAS-BP），腿部疼痛的VAS（VAS-LP），Oswestry残疾指数（ODI），患者满意度（PSR）和并发症发生率。
结果：本研究包括57例患者，随机分为两组：30例采用MISTLIF技术进行手术，和27通过Wiltse方法使用改进的开放TLIF技术进行操作。两组48个月的随访率相似。患者在基线ODI方面没有显著差异，VAS-BP,或VAS-LP。围手术期,MISTLIF与明显减少失血相关（167.3±80.0vs.297.9±81.5ml,p=1.1E-05)，稍长的程序（185.7±45.2vs.183.1±66.4分钟，p=0.76),较低的辐射剂量(MIS16.9±7.1vs.22.0±9.7mGyOPENp=0.012)，住院时间较短(MIS5.9±1.8vs.7.7±1.6天开放)。最常见的并发症是神经根炎，在MIS和TLIF组中分别占33%和37%，分别。第二个最常见的并发症是固定材料错位，TLIF组占18.5%,MIS组占20%。MIS组达到的融合水平为92.6％，而TLIF组为92.3％。MIS中镇痛药的消耗量较低。患者满意度（PSR）为90%。
结论：腰骶部退行性疾病患者MISTLIF后的临床和放射学结果通常是有利的。MISTLIF与围手术期失血减少有关，较低的辐射剂量和较早的放电，但是MISTLIF和改良开放TLIF在48个月的残疾方面没有差异，背痛,腿部疼痛,生活质量,或患者满意度或并发症发生率。尽管随着时间的推移差异逐渐减少，MISTLIF在围手术期和术后早期具有不可否认的优势。
