Kim Jin-Sung, Kang Byung-Uk, Lee Sang-Ho, Jung Byungjoo, Choi Young-Geun, Jeon Sang Hyeop, Lee Ho Yeon
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
J Spinal Disord Tech. 2009 Apr;22(2):114-21. doi: 10.1097/BSD.0b013e318169bff5.
Retrospective clinical data analysis.
To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis.
There is clear evidence that lumbar interbody fusion using anterior and posterior approaches provides a high fusion rate, good sagittal alignment, and good clinical outcomes. However, there are no recent studies that compare these 2 fusion techniques.
Between March 2004 and December 2004, 48 patients underwent instrumented mini-anterior lumbar interbody fusion (ALIF) and 46 underwent instrumented mini-transforaminal lumbar interbody fusion (TLIF). The mean follow-up periods were 32.6 and 29.7 months, respectively.
The mean visual analog scale (VAS) scores for back and leg pain decreased, respectively, from 7.7 and 7.5 to 2.9 and 2.7 in the ALIF group and from 7.0 and 6.3 to 2.3 and 2.2 in the TLIF group. The mean Oswestry disability index (ODI) scores improved from 51.4% to 23.2% in the ALIF group and from 52% to 14.4% in the TLIF group. In both groups, the VAS and ODI scores significantly changed preoperatively to postoperatively (P<0.001). However, statistical analysis showed no significant difference in postoperative VAS/ODI scores between groups. Radiologic evidence of fusion was noted in 95.8% and 92.3% of the patients in the ALIF group and the TLIF group, respectively. In both the groups, changes in the disc height, segmental lordosis, degree of listhesis, and whole lumbar lordosis (WL) between the preoperative and postoperative periods were significant except for WL in the TLIF group. The amount of change between preoperative and postoperative disc height, segmental lordosis, and WL demonstrated significant intergroup differences (P<0.05).
The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. However, clinical and functional outcomes did not demonstrate significant differences between groups.
回顾性临床数据分析。
比较两种融合技术治疗成人低度峡部裂型腰椎滑脱症的临床结果与影像学结果。
有明确证据表明，前后路腰椎椎间融合术具有较高的融合率、良好的矢状位对线及良好的临床疗效。然而，近期尚无比较这两种融合技术的研究。
2004年3月至2004年12月期间，48例患者接受了器械辅助下的微创前路腰椎椎间融合术（ALIF），46例患者接受了器械辅助下的微创经椎间孔腰椎椎间融合术（TLIF）。平均随访时间分别为32.6个月和29.7个月。
ALIF组患者的背部和腿部疼痛视觉模拟量表（VAS）平均评分分别从7.7和7.5降至2.9和2.7，TLIF组分别从7.0和6.3降至2.3和2.2。ALIF组的Oswestry功能障碍指数（ODI）平均评分从51.4%提高至23.2%，TLIF组从52%提高至14.4%。两组患者术前至术后的VAS和ODI评分均有显著变化（P<0.001）。然而，统计学分析显示两组术后VAS/ODI评分无显著差异。ALIF组和TLIF组分别有95.8%和92.3%的患者出现融合的影像学证据。两组患者术前至术后的椎间盘高度、节段性前凸、滑脱程度及整个腰椎前凸（WL）均有显著变化，但TLIF组的WL除外。术前至术后椎间盘高度、节段性前凸及WL的变化量显示出显著的组间差异（P<0.05）。
对于成人低度峡部裂型腰椎滑脱症，与微创TLIF组相比，微创ALIF组在影像学方面具有关键优势。然而，两组在临床和功能结果方面无显著差异。
