背景:本研究回顾性比较了经椎间孔腰椎椎间融合术(MIS-TLIF)和内窥镜下腰椎椎间融合术(Endo-LIF))治疗两节段腰椎退行性疾病的短期临床疗效和并发症,旨在指导脊柱外科医生选择手术入路。
方法:从2019年1月至2023年12月,纳入30例患者,MIS-TLIF组中的15和Endo-LIF组中的15。所有患者术后随访3个月以上,记录以下信息:(1)手术时间,术前和术后血红蛋白的差异,手术费用,手术后第一次下床,术后住院时间,术后并发症;(2)ODI评分(Oswestry残疾指数),腿和背部VAS评分(视觉模拟量表),和腰椎JOA评分(日本骨科协会评分);(3)最终随访时的MacNab评分,以评估临床结果,CT评价腰椎融合术。
结果:两组在手术时间和费用方面存在显著差异,MIS-TLIF组表现明显更好。与MIS-TLIF组相比,Endo-LIF组的术中出血明显减少。然而,术后第一次下床活动时间无显著差异,术后住院时间,术后并发症。术前VAS无显著差异,ODI,两个手术组之间的JOA在VAS(腿)方面没有显着差异,ODI,和JOA评分在两组前和第1天,7天,1个月,3个月和最后的随访。然而,术后1天,Endo-LIF组的VAS(背部)评分低于MIS-TLIF组,差异有统计学意义。在最后的后续行动中,根据Bridwell标准,所有患者均达到III级及以上,两组间比较差异无统计学意义。根据最后随访时的MacNab评分,Endo-LIF组优良率为80.00%,MIS-TLIF组优良率为73.33%,两组间无显著性差异。
结论:Endo-LIF和MIS-TLIF对两节段退行性腰椎疾病的短期疗效和安全性无明显差异。MIS-TLIF具有更短的手术时间和更低的成本,而Endo-LIF对组织的损伤较小,失血,术后早期疼痛,帮助长期恢复。MIS-TLIF和Endo-LIF均有望用于治疗两节段腰椎退行性疾病。外科手术的选择取决于病人的经济状况,他们耐受手术的能力,和外科医生的专业知识。
BACKGROUND: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches.
METHODS: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion.
RESULTS: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups.
CONCLUSIONS: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient\'s financial situation, their ability to tolerate surgery, and the surgeon\'s expertise.