Park Yung, Ha Joong Won
Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43. doi: 10.1097/01.brs.0000256473.49791.f4.
Prospective cohort study.
To determine the statistical difference between the minimally invasive and traditional open approach for one-level instrumented posterior lumbar interbody fusion by comparing the perioperative data, clinical outcome, and radiographic result.
Posterior lumbar fusion performed with mini-incision using tubular retractor has been advocated as a minimally invasive technique. Proponents have claimed that minimally invasive techniques reduce postoperative pain, blood loss, transfusion needs, and the length of hospital stay compared with the traditional open techniques. But there was no well-designed comparison study that supports these claims.
We studied a consecutive series of 61 patients who underwent one-level PLIF procedure (32 cases performed with minimally invasive approach and 29 cases with traditional open approach) by one surgeon at one hospital, from October 2003 until October 2004. The following data were compared between the 2 groups with 1-year minimum follow-up: the clinical and radiographic results, surgical time, estimated blood loss, transfusion needs, postoperative back pain by visual analogue scale, time needed before ambulation, length of hospital stay, and complications.
There was no significant difference between the 2 groups in the aspects of the clinical and radiographic results with 1-year minimum follow-up. The minimally invasive group was found to have a significantly less blood loss, less needs of transfusion, less postoperative back pain, shorter recovery time before ambulation, and shorter length of hospital stay. However, the minimally invasive group needed significantly longer surgical time and showed 2 cases of technical complications.
The present study, which was based on the authors' initial experience with the minimally invasive approach, could confirm favorable results reported by previous uncontrolled cohort studies in the aspects of less blood loss, less transfusion need, less postoperative back pain, quicker recovery, and shorter hospital stay. It also showed the similar surgical efficacy of the minimally invasive approach with that of the traditional open technique. However, the minimally invasive technique needs longer surgical time and a prudent attention to lower the risk of technical complications. Further long-term, prospective studies involving a larger study group are needed to determine the benefits of this minimally invasive percutaneous procedure.
前瞻性队列研究。
通过比较围手术期数据、临床结果和影像学结果，确定单节段器械辅助后路腰椎椎间融合术的微创方法与传统开放方法之间的统计学差异。
使用管状牵开器经小切口进行后路腰椎融合术已被倡导为一种微创技术。支持者声称，与传统开放技术相比，微创技术可减少术后疼痛、失血量、输血需求和住院时间。但尚无设计良好的比较研究支持这些说法。
我们研究了2003年10月至2004年10月期间在一家医院由一名外科医生连续进行单节段PLIF手术的61例患者（32例采用微创方法，29例采用传统开放方法）。对两组进行至少1年的随访，比较以下数据：临床和影像学结果、手术时间、估计失血量、输血需求、视觉模拟量表评估的术后背痛、下床活动所需时间、住院时间和并发症。
在至少1年的随访中，两组在临床和影像学结果方面无显著差异。发现微创组失血量明显减少、输血需求减少、术后背痛减轻、下床活动恢复时间缩短、住院时间缩短。然而，微创组手术时间明显更长，并有2例技术并发症。
本研究基于作者对微创方法的初步经验，证实了先前非对照队列研究报告的在失血量减少、输血需求减少、术后背痛减轻、恢复更快和住院时间缩短方面的良好结果。它还显示了微创方法与传统开放技术相似的手术疗效。然而，微创技术需要更长的手术时间，并且需要谨慎注意以降低技术并发症的风险。需要进一步进行涉及更大研究组的长期前瞻性研究，以确定这种微创经皮手术的益处。
