背景:腰椎外侧椎间融合术是治疗多种脊柱病变的革命性方法,因为该技术能够通过微创方法促进间接减压和脊柱前凸恢复,从而减少患者的失血量和早期恢复。然而,目前尚不清楚该技术与其他已建立的治疗脊柱退行性疾病的方法相比,例如TLIF,PLIF,PLF。
方法:这是对最近10年发表的比较横向入路与后部入路技术的文章的系统回顾和荟萃分析。作者包括将LLIF技术与一种或多种后路入路进行比较的文章,只治疗退行性病变,并包含至少一项研究的关键结果。排除非原创文章和作者无法获得全文的文章;也排除了没有可能计算标准偏差或平均值的文章。对于计数变量,使用了赔率比,对于连续变量,使用标准平均差(SMD),随机或固定效应模型之间的选择取决于样本中是否存在显著(p<0.05)异质性。
结果:24篇文献纳入定量综述。至于围手术期/围手术期变量,侧方入路显示失血量显著减少(SMD-1.56,p<0.001),手术时间相似(SMD=-0.33,p=0.24)。此外,横向入路的使用显示出导致住院天数减少的趋势(SMD=-0.15,p=0.09),并发症的比值比显着降低(0.53,p=0.01)。至于临床结果,两种方法在改进时都表现出类似的改进,就最后一次随访值而言,ODI或VAS-BP。最后,在分析节段前凸和腰椎前凸的变化时,侧位技术在两种结局中都显著提高了矫正率(p<0.05).
结论:侧入路可促进显著的放射学矫正和类似的临床改善,同时减少手术失血量和术后并发症。
The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF.
This is a systematic
review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the
LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample.
Twenty-four articles were included in the quantitative
review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05).
Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.