Freudenberger Curt, Lindley Emily M, Beard Douglas W, Reckling W Carlton, Williams Allison, Burger Evalina L, Patel Vikas V
SportsMed, Huntsville, Alabama, USA.
Orthopedics. 2009 Jul;32(7):492. doi: 10.3928/01477447-20090527-12.
Over the past 2 decades, posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation has gained popularity. Anterior fusion techniques, however, have evolved over time and currently allow for minimally invasive anterior retroperitoneal diskectomy, interbody graft placement, and rigid instrumentation. A direct comparison of anterior lumbar interbody fusion (ALIF) with anterior tension band plating to that of instrumented PLIF has not been previously reported. This retrospective uncontrolled cohort comparison included 59 patients with low back pain and 1- or 2-level lumbar degenerative disk disease from L3 to S1 who underwent PLIF with pedicle screw instrumentation or ALIF with anterior tension band plating. Outcome measures included estimated blood loss, surgical time, radiographic evidence of fusion at 6 to 9 months postoperatively, and pre- and postoperative Oswestry Disability Index scores. Fusion rates for the 2 procedures were similar. Posterior lumbar interbody fusion patients had significantly higher estimated blood loss and longer surgical time than ALIF-ATB patients. Oswestry Disability Index scores were similar between the 2 groups at all postoperative time points, except at 3 months postoperatively when PLIF patients had lower scores than ALIF-ATB patients. These findings suggest that ALIF-ATB has similar fusion and functional outcomes as PLIF, but with shorter surgical time and decreased blood loss.
在过去20年中，后路腰椎椎间融合术（PLIF）联合椎弓根螺钉内固定术已得到广泛应用。然而，前路融合技术也随着时间不断发展，目前已能实现微创前路腹膜后椎间盘切除术、椎间植骨融合及坚强内固定。此前尚未有关于前路腰椎椎间融合术（ALIF）联合前路张力带钢板与器械辅助PLIF的直接对比报道。这项回顾性非对照队列比较研究纳入了59例患有下腰痛且存在L3至S1节段1或2级腰椎退行性椎间盘疾病的患者，这些患者接受了椎弓根螺钉内固定的PLIF或前路张力带钢板固定的ALIF。观察指标包括估计失血量、手术时间、术后6至9个月时融合的影像学证据以及术前和术后的Oswestry功能障碍指数评分。两种手术的融合率相似。后路腰椎椎间融合术患者的估计失血量显著高于ALIF-ATB患者，手术时间也更长。在所有术后时间点，两组的Oswestry功能障碍指数评分相似，但在术后3个月时，PLIF患者的评分低于ALIF-ATB患者。这些结果表明，ALIF-ATB与PLIF具有相似的融合及功能效果，但手术时间更短，失血量更少。
