方法:系统综述和荟萃分析。
目的:本系统评价和荟萃分析的目的是比较腰椎侧路融合术(LLIF)联合后路脊柱融合术(PSF)与常规PSF治疗成人脊柱畸形(ASD)的疗效。
方法:对PubMed的相关研究进行了全面的文献检索,EMBASE,WebofScience,还有Cochrane图书馆.脊柱骨盆参数,手术数据,并发症,比较接受LLIF联合PSF治疗的ASD患者(LLIF+PSF组)和接受常规PSF治疗的ASD患者(仅PSF组)末次随访时的临床结局.
结果:十项研究,包括621例ASD患者(LLIFPSF组313例,仅PSF组308例),包括在内。7项研究的证据水平为III,3项研究为IV。视觉模拟量表评分改善无显著差异,全身并发症发生率,和组间修订率。在LLIF+PSF组中,我们注意到腰椎前凸的良好恢复(加权平均差[WMD],9.77;95%置信区间[CI]7.10至12.44,P<.001),骨盆倾斜(WMD,-2.50;95%CI-4.25至-.75,P=0.005),矢状垂直轴(WMD,-21.92;95%CI-30.73至-13.11,P<.001),和C7铅垂线-中心骶骨垂直线(WMD,-4.03;95%CI-7.52至-.54,P=.024);较低的估计失血量(WMD,-719.99;95%CI-1105.02至-334.96,P<.001),而延长的运行时间(WMD,104.89;95%CI49.36至160.43,P<.001);假关节发生率较低(风险比[RR],.26;95%CI.08至.79,P=.017),而神经功能缺损的发生率较高(RR,2.04;95%CI1.27至3.25,P=.003);Oswestry残疾指数评分有更好的改善(WMD,-7.04;95%CI-10.155至-3.93,P<.001)和脊柱侧弯研究学会-22总分(WMD,.27;95%CI.11至.42,P=.001)。本系统评价和荟萃分析的证据水平为II。
结论:与常规PSF相比,LLIF联合PSF与矢状位和冠状位的上恢复相关,假关节的发生率较低,更好地提高生活质量,在ASD的治疗中,手术侵入性较小,尽管代价是手术时间延长和下肢症状的发生率很高。外科医生应该权衡这个程序的利弊,并告知患者其副作用。
METHODS: A systematic review and meta-analysis.
OBJECTIVE: The purpose of this systematic review and meta-analysis was to compare the efficacy of lateral lumbar interbody fusion (LLIF) combined with posterior spinal fusion (PSF) with that of conventional PSF in the treatment of adult spinal deformity (ASD).
METHODS: A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, and the Cochrane Library. Spinopelvic parameters, surgical data, complications, and clinical outcomes at the last follow-up were compared between patients with ASD who underwent LLIF combined with PSF (LLIF+PSF group) and those who underwent conventional PSF (only-PSF group).
RESULTS: Ten studies, comprising 621 patients with ASD (313 in the LLIF+PSF group and 308 in the only-PSF group), were included. The level of evidence was III for 7 studies and IV for 3 studies. There was no significant difference in the improvement in the visual analog scale score, systemic complication rate, and revision rate between groups. In the LLIF+PSF group, we noted a superior restoration of lumbar lordosis (weighted mean difference [WMD], 9.77; 95% confidence interval [CI] 7.10 to 12.44, P < .001), pelvic tilt (WMD, -2.50; 95% CI -4.25 to -.75, P = .005), sagittal vertical axis (WMD, -21.92; 95% CI -30.73 to -13.11, P < .001), and C7 plumb line-center sacral vertical line (WMD, -4.03; 95% CI -7.52 to -.54, P = .024); a lower estimated blood loss (WMD, -719.99; 95% CI -1105.02 to -334.96, P < .001) while a prolonged operating time (WMD, 104.89; 95% CI 49.36 to 160.43, P < .001); lower incidence of pseudarthrosis (risk ratio [RR], .26; 95% CI .08 to .79, P = .017) while higher incidence of neurologic deficits (RR, 2.04; 95% CI 1.27 to 3.25, P = .003); and a better improvement in Oswestry Disability Index score (WMD, -7.04; 95% CI -10.155 to -3.93, P < .001) and Scoliosis Research Society-22 total score (WMD, .27; 95% CI .11 to .42, P = .001). The level of evidence in this systematic review and meta-analysis was II.
CONCLUSIONS: Compared with conventional PSF, LLIF combined with PSF was associated with superior restoration of sagittal and coronal alignment, lower incidence of pseudarthrosis, better improvement in quality of life, and less surgical invasiveness in the treatment of ASD, albeit at the cost of prolonged surgical times and substantially high incidence of lower extremity symptoms. Surgeons should weigh the advantages and disadvantages of this procedure, and inform patients about its side effects.