Rodriguez-Olaverri Juan C, Zimick Nicholas C, Merola Andrew, Vicente Javier, Rodriguez Javier, Tabuenca Antonio, Loste Antonio, Suñen Enrique, Burgos Jesus, Hevia Eduardo, Piza-Vallespir Gabriel
Maimonides Medical Center, Brooklyn, NY, USA.
Spine (Phila Pa 1976). 2008 Aug 15;33(18):1977-81. doi: 10.1097/BRS.0b013e31817ecc01.
This study retrospectively compares the clinical and radiologic outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with those of transvertebral screw fixation of the lumbosacral spine in high-grade spondylolisthesis.
To examine the outcome and perioperative complications of unilateral TLIF and compare those results with Transvertebral Screw Fixation in the treatment of high-grade spondylolisthesis.
High-grade spondylolisthesis has been associated with a high complication and failure rate regardless of the method of treatment. We compare 2 techniques to improve success rates.
Forty patients were divided into 2 groups: group A, unilateral TLIF, and group B, transacral screws. The mean age was 33 years (range, 19-48 years), and the mean follow-up was 35 months (range, 24-48 months). The mean grade of spondylolisthesis measured by Meyerding grading was 3.6 (range, 3-5). A Scoliosis Research Society outcome score was obtained on all patients. Fusion was determined by both radiograph and computed tomography scan.
Group A: 100% fusion. The slip angle improved from 38.6 degrees (range, 24-78 degrees ) before surgery to 23.8 degrees (range, 12-38 degrees ) after surgery. Group B: 95% of patients evidenced solid fusion by the 6-month follow-up. The slip angle, improved from 38.2 degrees (range, 22-78 degrees ) before surgery to 23 degrees (range, 9-36 degrees ) after surgery. There was no significant improvement in the percentage slip or the sacral inclination in any of the groups.
A: 7 unintended durotomies and 3 wound infections. B: 1 unintended durotomy, 1 pseudarthrosis, 2 wound infections, and 1 implant failure. There were no neurologic complications in any of the groups. The Scoliosis Research Society outcome instrument demonstrated good postoperative pain control, function, self-image, and satisfaction in both groups.
No significant differences in radiologic and clinical outcome were found, in either group. Both procedures appear to be safe and effective surgically and radiographically.
本研究回顾性比较了单侧经椎间孔腰椎椎间融合术（TLIF）与腰骶椎经椎弓根螺钉固定术治疗重度腰椎滑脱的临床和影像学结果。
探讨单侧TLIF的疗效及围手术期并发症，并将这些结果与经椎弓根螺钉固定术治疗重度腰椎滑脱的结果进行比较。
无论采用何种治疗方法，重度腰椎滑脱都与高并发症率和失败率相关。我们比较两种技术以提高成功率。
40例患者分为两组：A组，单侧TLIF；B组，经骶骨螺钉固定术。平均年龄33岁（范围19 - 48岁），平均随访35个月（范围24 - 48个月）。根据Meyerding分级法测得的腰椎滑脱平均程度为3.6级（范围3 - 5级）。对所有患者进行脊柱侧凸研究学会疗效评分。通过X线片和计算机断层扫描确定融合情况。
A组：融合率100%。滑脱角从术前的38.6度（范围24 - 78度）改善至术后的23.8度（范围12 - 38度）。B组：95%的患者在6个月随访时显示牢固融合。滑脱角从术前的38.2度（范围22 - 78度）改善至术后的23度（范围9 - 36度）。两组中任何一组的滑脱百分比或骶骨倾斜度均无显著改善。
A组：7例意外硬脊膜切开和3例伤口感染。B组：1例意外硬脊膜切开、1例假关节形成、2例伤口感染和1例内固定失败。两组均无神经并发症。脊柱侧凸研究学会疗效评估工具显示两组术后疼痛控制、功能、自我形象和满意度均良好。
两组在影像学和临床结果方面均未发现显著差异。两种手术在手术和影像学方面似乎都是安全有效的。
