器械辅助微创经椎间孔腰椎椎体间融合术（MIS-TLIF）：至少5年的临床和影像学结果随访

Instrumented Minimally Invasive Spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF): Minimum 5-Year Follow-Up With Clinical and Radiologic Outcomes.

作者信息

Kim Jin-Sung, Jung Byungjoo, Lee Sang-Ho

机构信息

Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.

出版信息

Clin Spine Surg. 2018 Jul;31(6):E302-E309. doi: 10.1097/BSD.0b013e31827415cd.

DOI:10.1097/BSD.0b013e31827415cd

PMID:23027364

Abstract

STUDY DESIGN

A retrospective study.

OBJECTIVE

To determine the clinical and radiologic outcomes of the long-term results of instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF) in unstable, single-level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disk disease, and recurrent disk herniation.

SUMMARY OF BACKGROUND DATA

MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF.

METHODS

Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005 were retrospectively reviewed. The visual analog scale, Oswestry Disability Index, patient satisfaction rate, and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiologic follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, computed tomography and magnetic resonance imaging, were used in all patients in last follow-up period.

RESULTS

The mean visual analog scale scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7, respectively, in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0, respectively, in the IS group (n=25) (P<0.001). The mean Oswestry Disability Index scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). Patient satisfaction rate was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group, respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD.

CONCLUSIONS

The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable.

摘要

研究设计

一项回顾性研究。

目的

确定器械辅助下微创经椎间孔腰椎椎体间融合术（MIS-TLIF）治疗不稳定单节段、低度峡部裂型腰椎滑脱（IS）或退变性脊椎病（DS，包括退变性腰椎滑脱、伴有中央管狭窄的椎间孔狭窄、椎间盘退变疾病和复发性椎间盘突出症）的长期临床和影像学结果。

背景资料总结

MIS-TLIF是治疗腰椎滑脱的常见手术方式。然而，尚无研究记录MIS-TLIF的长期结果。

方法

对2003年7月至2005年1月期间接受器械辅助下MIS-TLIF手术的44例患者进行回顾性分析。采用视觉模拟评分法、Oswestry功能障碍指数、患者满意度及患者重返工作岗位情况评估临床和功能结果。对患者进行影像学随访以检查相邻节段退变（ASD）情况。在最后随访期对所有患者均行X线平片、计算机断层扫描和磁共振成像检查。

结果

DS组（n = 19）下腰痛和腿痛的视觉模拟评分均值分别从5.8和7降至3.5和3.7，IS组（n = 25）分别从6.8和6.9降至1.8和2.0（P < 0.001）。DS组Oswestry功能障碍指数评分均值从61.7%改善至21.5%，IS组从53.9%改善至16%（P < 0.001）。DS组和IS组患者满意度分别为80%和81%。IS组和DS组分别有24例（96%）和19例（100%）患者影像学检查显示融合征象，总体融合率为97.7%（43/44）。采用X线检查观察到的最终ASD发生率，DS组为68.4%（13/19），IS组为40%（10/25）。然而，DS组15.8%（3/19）和IS组4%（1/25）的患者出现与ASD相关的症状。