Kotil Kadir, Ali Akçetin Mustafa, Savaş Yildiray
*Department of Neurosurgery, Istanbul Educational and Research Hospital †Department of Neurosurgery ‡Department of Radiology, Haseki Educational and Research Hospital, Istanbul, Turkey.
J Spinal Disord Tech. 2013 Oct;26(7):359-66. doi: 10.1097/BSD.0b013e318249599f.
Prospective cohort data by merging data from comparative studies.
This study aimed to compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease.
The unilateral lumbar interbody fusion technique has gained popularity in the management of many lumbar degenerative conditions requiring fusion. TLIF is routinely performed with the support of pedicle screws. The use of the TLIF procedure without pedicle screw support has not yet been reported.
Between February 2006 and May 2009, surgical decompression and fusion was performed in patients with lumbar degenerative conditions using the TLIF technique either with (n=30, group A) or without pedicle screw support (n=30, group B). The 2 groups had similar age, sex distribution, pain level, and pain history. In this prospective study, patients were followed for a mean period of 31 months (range, 22 to 38 mo). The mean age was 45.5 years (range, 29 to 78 y), and all patients had a disease involving a single intervertebral space.
The female to male ratio was 19:11 and 18:12 in groups A and B, respectively. Pain and function were evaluated by the Oswestry disability index and visual analog scale. Pseudoarthrosis developed in 2 patients from group A and in 3 patients from group B. Although these 5 patients had insufficient fusion, they did show a clinical improvement. The mean duration of the operation was 110 and 73 minutes in groups A and B, respectively. The mean total amount of bleeding was 410 and 220 mL in groups A and B, respectively. Cage loosening did not occur in group A, but 1 patient in group B developed asymptomatic cage loosening limited to the endplates. Four patients in group A suffered sciatic pain because of the malposition of the screw, and 1 patient in group B had contralateral sciatic pain lasting for 2 months. The visual analog scale and Oswestry disability index scores were higher in group A than in group B 1 month after the operation (P<0.005), but the groups did not significantly differ at 3 months (P<0.89). The cost of the procedure was 3-fold higher in group A compared with group B.
This study showed that the TLIF procedure without pedicle screw support would be sufficient in the management of preoperatively stable patients with lumbar degenerative spinal disease requiring fusion after single-level decompression. This technique is minimally invasive, requires only unilateral intervention, allows magnetic resonance imaging during the postoperative period and is associated with less costs and complications when compared with pedicle screwing. This study represents the first prospective comparative report on this technique showing several of its advantages.
通过合并比较研究的数据得出前瞻性队列数据。
本研究旨在比较在患有退行性疾病的稳定患者中，有或没有椎弓根螺钉支撑的经椎间孔腰椎椎体间融合术（TLIF）的临床和放射学结果。
单侧腰椎椎体间融合技术在许多需要融合的腰椎退行性疾病的治疗中越来越受欢迎。TLIF通常在椎弓根螺钉的支撑下进行。尚未有关于不使用椎弓根螺钉支撑进行TLIF手术的报道。
在2006年2月至2009年5月期间，对患有腰椎退行性疾病的患者采用TLIF技术进行手术减压和融合，其中有椎弓根螺钉支撑的患者30例（A组），无椎弓根螺钉支撑的患者30例（B组）。两组患者在年龄、性别分布、疼痛程度和疼痛病史方面相似。在这项前瞻性研究中，患者平均随访31个月（范围为22至38个月）。平均年龄为45.5岁（范围为29至78岁），所有患者均患有累及单个椎间隙的疾病。
A组和B组的男女比例分别为19:11和18:12。通过Oswestry功能障碍指数和视觉模拟量表评估疼痛和功能。A组有2例患者发生假关节形成，B组有3例患者发生假关节形成。尽管这5例患者融合不足，但他们确实显示出临床改善。A组和B组的平均手术时间分别为110分钟和73分钟。A组和B组的平均总出血量分别为410毫升和220毫升。A组未发生椎间融合器松动，但B组有1例患者出现仅限于终板的无症状椎间融合器松动。A组有4例患者因螺钉位置不当出现坐骨神经痛，B组有1例患者出现对侧坐骨神经痛持续2个月。术后1个月，A组的视觉模拟量表和Oswestry功能障碍指数评分高于B组（P<0.005），但在3个月时两组无显著差异（P<0.89）。A组手术费用是B组的3倍。
本研究表明，对于术前稳定的需要单节段减压融合的腰椎退行性脊柱疾病患者，不使用椎弓根螺钉支撑的TLIF手术就足够了。与椎弓根螺钉固定相比，该技术创伤小，仅需单侧干预，术后可进行磁共振成像，且成本和并发症更少。本研究是关于该技术的首份前瞻性比较报告，显示了其若干优势。
