Ntoukas V, Müller A
Department of Neurosurgery, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany.
Minim Invasive Neurosurg. 2010 Feb;53(1):21-4. doi: 10.1055/s-0030-1247560. Epub 2010 Apr 7.
While over the last ten years minimally invasive posterior lumbar interbody fusion (PLIF) has been acknowledged to (i) reduce approach-related morbidity associated with quicker recovery, (ii) require a shorter hospital stay and (iii) deliver similar clinical outcomes when compared to a traditional approach, it is still not the current gold standard. In order to demonstrate the efficacy of the minimally invasive lumbar PLIF approach, a retrospective study was conducted comparing both approaches.
A retrospective study was conducted with 40 patients treated for one level, degenerative lumbar instability. 20 patients received lumbar PLIF though a standard open approach, while another 20 underwent a minimally invasive approach using the "SpiRIT"-system. Spinal pathological features, stabilized segments, number of implanted pedicle screws, surgical time, radiation time, blood loss, complications, radiographic images and standardized patient questionnaires (VAS, ODI) were evaluated. The follow-up period was one year.
One year after the performed surgery, we found no significant difference between the two groups with regard to clinical and radiographic outcome. However, in the minimally invasive group we noticed less blood loss, less postoperative pain, a shorter recovery time and a shorter hospital stay. Despite these benefits, the minimally invasive group also experienced a longer surgical and radiation time as compared to the "open" group.
This study confirmed the results of previous studies which advocated the advantages of less blood loss, less postoperative pain, quicker recovery and shorter duration of hospitalization. However, in the long run, one year after surgery, both groups showed no significant difference with regards to clinical and radiographic outcome. Therefore long-term controlled studies are necessary to validate the role of the minimally invasive PLIF in degenerative lumbar instability.
在过去十年间，尽管微创后路腰椎椎间融合术（PLIF）已被认可具有以下优点：（i）减少与更快康复相关的手术入路相关发病率；（ii）缩短住院时间；（iii）与传统手术方法相比能带来相似的临床疗效，但它仍不是当前的金标准。为了证明微创腰椎PLIF手术方法的疗效，开展了一项对比两种手术方法的回顾性研究。
对40例因单节段退变性腰椎不稳接受治疗的患者进行回顾性研究。20例患者通过标准开放手术方法接受腰椎PLIF手术，另外20例采用“SpiRIT”系统进行微创手术。对脊柱病理特征、固定节段、植入椎弓根螺钉数量、手术时间、透视时间、失血量、并发症、影像学图像以及标准化患者问卷（视觉模拟评分法[VAS]、腰椎功能障碍指数[ODI]）进行评估。随访期为一年。
手术一年后，我们发现两组在临床和影像学结果方面无显著差异。然而，在微创组中，我们注意到失血量更少、术后疼痛更轻、恢复时间更短且住院时间更短。尽管有这些优点，但与“开放”组相比，微创组的手术和透视时间也更长。
本研究证实了先前研究的结果，即微创腰椎PLIF具有失血量更少、术后疼痛更轻、恢复更快以及住院时间更短的优点。然而，从长远来看，手术后一年，两组在临床和影像学结果方面无显著差异。因此，需要进行长期对照研究来验证微创PLIF在退变性腰椎不稳中的作用。
