Peng Chan Wearn Benedict, Yue Wai Mun, Poh Seng Yew, Yeo William, Tan Seang Beng
Singapore General Hospital, Outram Road, Singapore.
Spine (Phila Pa 1976). 2009 Jun 1;34(13):1385-9. doi: 10.1097/BRS.0b013e3181a4e3be.
Prospective study.
Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF).
Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery.
From 2004-2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years.
The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P < 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P < 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P < 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P < 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P < 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P < 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P < 0.05), and Quality of Life scores (Short Form-36, P < 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P > 0.05).
MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.
前瞻性研究。
比较微创（MIS）与开放经椎间孔腰椎椎间融合术（TLIF）的临床和影像学结果。
开放TLIF已开展多年，效果良好。MIS TLIF技术最近被引入，旨在实现更小的伤口和更快的恢复。
2004年至2006年，29例MIS TLIF与29例开放TLIF进行配对。收集患者人口统计学和手术数据。在手术前、术后6个月和2年进行北美脊柱协会、Oswestry功能障碍指数、简明健康状况调查36项量表和视觉模拟评分的临床评估。在术后2年根据Bridwell分级评估融合率。
MIS手术和开放手术的平均年龄分别为54.1岁和52.5岁。两组均有24名女性和5名男性。MIS组的透视时间（105.5秒）和手术时间（216.4分钟）长于开放组（分别为35.2秒和170.5分钟，P<0.05）。MIS手术的失血量（150毫升）少于开放手术（681毫升，P<0.05）。MIS组使用的吗啡总量（17.4毫克）少于开放组（35.7毫克，P<0.05）。MIS组患者的住院时间（4天）短于开放组（6.7天，P<0.05）。MIS组和开放组在术后6个月和2年时的Oswestry功能障碍指数（P<0.05）、背痛和下肢症状（北美脊柱协会和视觉模拟评分，P<0.05）以及生活质量评分（简明健康状况调查36项量表，P<0.05）均有显著改善，但两组之间无显著差异。80%的MIS TLIF和86.7%的开放TLIF节段达到1级融合（P>0.05）。
MIS TLIF与开放TLIF具有相似良好的长期临床结果和高融合率，且具有术后初期疼痛较轻、早期康复、住院时间较短和并发症较少的额外益处。
