Kasis Ata G, Marshman Laurence A G, Krishna Manoj, Bhatia Chandra K
Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees.
Spine (Phila Pa 1976). 2009 Mar 15;34(6):572-7. doi: 10.1097/BRS.0b013e3181973e35.
Original study.
Prospective comparison of clinical outcomes after a standard posterior lumbar interbody fusion (ST-PLIF) and after a limited exposure PLIF incorporating total facetectomy (LI-PLIF).
Most groups have reported significantly improved clinical outcomes after ST-PLIF. To our knowledge, however, a comparison of outcomes between ST-PLIF and the LI-PLIF that we herein describe has not been reported before.
Patients were included who had suffered chronic low back pain for a minimum of 2 years that was unresponsive to conservative treatment. N = 114 consecutive patients underwent ST-PLIF, whereas n = 209 underwent LI-PLIF. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index (ODI), short-form 36 (SF-36), and visual analogue scores (VAS). The minimum follow-up for either group was 2 years.
There was a significant improvement in the ODI (22.5 +/- 1.0, P < 0.001), VAS for back pain (3.8 +/- 0.1, P = 0.003), VAS for leg pain (4.0 +/- 0.2, P = 0.002), and SF-36 for bodily pain (14.7 +/- 0.9, P = 0.012) after ST-PLIF. However, there was a significantly greater improvement in all scores after LI-PLIF: ODI (28.8 +/- 1.4 vs. 22.5 +/- 1.0, P < 0.001), VAS for back pain (5.4 +/- 0.2 vs. 3.8 +/- 0.1, P = 0.001), VAS for leg pain (5.1 +/- 0.2 vs. 4.0 +/- 0.2, P < 0.001), and SF-36 for bodily pain (18.5 +/- 0.8 vs. 14.7 +/- 0.9, P = 0.003). There was a significantly shorter duration of hospital stay after LI-PLIF (2.24 +/- 0.057 days) than after ST-PLIF (4.04 +/- 0.13 days) (P = 0.005). Operative complications occurred in 19.3% of ST-PLIF and in 6.7% of LI-PLIF.
Clinical outcomes were significantly improved after both ST-PLIF and LI-PLIF. However, outcomes were significantly better after LI-PLIF than after ST-PLIF. Significantly shortened hospital stay with LI-PLIF probably reflected the "less invasive" technique per se. Significantly better clinical outcomes with fewer complications after LI-PLIF, however, potentially reflected maneuvers singular to LI-PLIF: (1) preservation of posterior elements, (2) avoidance of far lateral dissection over the transverse processes, (3) bilateral total facetectomy, (4) fewer neurologic complications, and (5) avoidance of iliac crest autograft. LI-PLIF is therefore recommended over ST-PLIF.
原创性研究。
对标准后路腰椎椎间融合术（ST-PLIF）与有限暴露经全椎板切除术的腰椎椎间融合术（LI-PLIF）后的临床疗效进行前瞻性比较。
大多数研究组报告ST-PLIF术后临床疗效显著改善。然而，据我们所知，此前尚未有关于ST-PLIF与本文所述LI-PLIF疗效比较的报道。
纳入至少2年慢性下腰痛且保守治疗无效的患者。114例连续患者接受ST-PLIF，209例接受LI-PLIF。所有患者术前和术后均接受Oswestry功能障碍指数（ODI）、简明健康状况调查量表（SF-36）和视觉模拟评分（VAS）评估。两组的最短随访时间均为2年。
ST-PLIF术后ODI（22.5±1.0，P<0.001）、腰痛VAS（3.8±0.1，P=0.003）、腿痛VAS（4.0±0.2，P=0.002）及SF-36身体疼痛评分（14.7±0.9，P=0.012）均有显著改善。然而，LI-PLIF术后所有评分改善更为显著：ODI（28.8±1.4 vs. 22.5±1.0，P<0.001）、腰痛VAS（5.4±0.2 vs. 3.8±0.1，P=0.001）、腿痛VAS（5.1±0.2 vs. 4.0±0.2，P<0.001）及SF-36身体疼痛评分（18.5±0.8 vs. 14.7±0.9，P=0.003）。LI-PLIF术后住院时间（2.24±0.057天）显著短于ST-PLIF术后（4.04±0.13天）（P=0.005）。ST-PLIF手术并发症发生率为19.3%，LI-PLIF为6.7%。
ST-PLIF和LI-PLIF术后临床疗效均显著改善。然而，LI-PLIF术后疗效显著优于ST-PLIF。LI-PLIF住院时间显著缩短可能本身就反映了其“微创”技术特点。然而，LI-PLIF术后临床疗效显著更好且并发症更少，可能反映了LI-PLIF独有的操作：（1）保留后部结构；（2）避免横突上的极外侧剥离；（3）双侧全椎板切除术；（4）神经并发症较少；（5）避免髂嵴自体骨移植。因此，推荐LI-PLIF优于ST-PLIF。
