Department of Neurosurgery, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Starkenburgring 66, 63069 Offenbach, Germany.
Eur Spine J. 2013 Aug;22(8):1731-40. doi: 10.1007/s00586-013-2732-6. Epub 2013 Mar 12.
The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO).
From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short- and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain.
Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29% in the MIS group vs. 28% in the open group, p = 0.999).
Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.
本研究的目的是比较微创外科（MIS）与开放手术治疗严重退行性腰椎滑脱伴严重狭窄（SDS）和高等级关节突关节炎（FJO）的严重受影响亚组患者的疗效。
2009 年 1 月至 2010 年 2 月，49 例严重 SDS 和高等级 FJO 患者接受了 MIS 或开放 TLIF 治疗。通过回顾性图表审查收集了包括围手术期并发症和住院时间（LOS）在内的术中及诊断数据。根据 Oswestry 残疾指数（ODI）和腰背腿痛视觉模拟评分（VAS）评估手术的短期和长期疗效。
与开放手术相比，MIS 组失血量较少，输血需求显著减少（p = 0.02），术后腰背疼痛在随访的前 6 周恢复更快，住院时间更短。另一方面，我们在 MIS 组中发现手术时间较长。在平均随访 2 年后，两组患者的术后 ODI 评分（p = 0.841）、VAS 腿痛评分（p = 0.943）和腰痛评分（p = 0.735）分布相似。两组并发症的总体比例无显著差异（MIS 组 29%，开放组 28%，p = 0.999）。
严重 SDS 的微创外科治疗可充分、安全地减压腰椎狭窄，并在术后早期更快地缓解症状和残疾。
