Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S57-65. doi: 10.1097/BRS.0b013e3181d82bb8.
Systematic review.
The purpose of this review was to attempt to answer the following 2 clinical questions: (1) Does minimal access tubular assisted spine surgery (MAS) decrease the rate of complications in posterior thoracolumbar decompression and/or fusion surgery compared with traditional open techniques? (2) What strategies to reduce the risk of complications in MAS have been shown to be effective?
The objective of minimal access spine surgery is to reduce damage to surrounding tissues while accomplishing the same goals as conventional surgery. Patient demand and marketing for MAS is driven by the perception of better outcomes, although the purported advantages remain unproven. Whether the risk of complications is affected by minimal access techniques is unknown.
A systematic review of the English language literature was undertaken for articles published between 1990 and July 2009. Electronic databases and reference lists of key articles were searched to identify published studies that compared the rate of complications after MAS to a control group that underwent open surgery. Single-arm studies were excluded. Two independent reviewers assessed the strength of literature using GRADE criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.
From the 361 articles identified, 13 met a priori criteria and were included for review. All of the studies evaluated only lumbar spine surgery. The single large randomized study showed less favorable results for MAS discectomy, but no significant difference in complication rates. The quality of the other studies, particularly for fusion surgery, was low. Overall, the rates of reoperation, dural tear, cerebrospinal fluid leak, nerve injury, and infection occurred in similar proportions between MAS and open surgery. Blood loss was reduced in MAS fusion; however, the quality of those studies was very low. Operation time and hospital length of stay was variable across studies. There was no evidence to assess the effectiveness of strategies to reduce the risk of complications in MAS. Some data suggests that the rate of complications may decrease with experience.
(1) Compared to open techniques, MAS does not decrease the rate of complications for posterior lumbar spinal decompression or fusion. (2) There is no evidence to assess the effectiveness of strategies to reduce the risk of MAS-related complications.
系统回顾。
本研究旨在尝试回答以下两个临床问题：（1）与传统开放技术相比，微创管状辅助脊柱手术（MAS）是否能降低后路胸腰椎减压和/或融合手术的并发症发生率？（2）哪些减少 MAS 并发症风险的策略已被证明是有效的？
微创脊柱手术的目的是在达到与传统手术相同目标的同时，减少对周围组织的损伤。尽管微创技术的潜在优势尚未得到证实，但 MAS 的市场需求和营销是基于对更好结果的预期。微创技术是否会影响并发症的风险尚不清楚。
对 1990 年至 2009 年 7 月期间发表的英文文献进行了系统回顾。检索电子数据库和关键文章的参考文献列表，以确定将 MAS 后并发症发生率与接受开放手术的对照组进行比较的已发表研究。排除单臂研究。两名独立评审员使用 GRADE 标准评估文献的强度，评估结果的质量、数量和一致性。通过共识解决分歧。
从 361 篇文章中，有 13 篇符合先验标准并被纳入审查。所有研究仅评估了腰椎手术。唯一一项大型随机研究显示 MAS 椎间盘切除术的结果较差，但并发症发生率无显著差异。其他研究的质量较低，特别是融合手术。总体而言，MAS 和开放手术的再手术、硬脑膜撕裂、脑脊液漏、神经损伤和感染发生率相似。MAS 融合术的失血量减少，但这些研究的质量非常低。手术时间和住院时间因研究而异。没有证据评估降低 MAS 相关并发症风险的策略的有效性。一些数据表明，随着经验的增加，并发症的发生率可能会降低。
（1）与开放技术相比，MAS 不会降低后路腰椎减压或融合的并发症发生率。（2）没有证据评估降低 MAS 相关并发症风险的策略的有效性。
