Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA.
Neurosurg Focus. 2013 Aug;35(2):E6. doi: 10.3171/2013.5.FOCUS1377.
Previous studies comparing minimally invasive transforaminal lumbar interbody fusion (MITLIF) with open TLIF have demonstrated that MITLIF reduces blood loss and decreases postoperative pain while preserving fusion rates and reducing complications. In this study, the authors wanted to compare outcomes of MITLIF with those of open TLIF to determine whether MITLIF also improves postoperative functional mobility and decreases the usage of pain medication.
In total, 75 consecutive patients who underwent either single-level open TLIF or MITLIF at the University of California, San Francisco, between 2006 and 2011 were included, and patients were followed up for an average of 5.05 years. Fifty patients underwent MITLIF and 25 underwent open TLIF. Primary outcomes included administration of morphine-equivalent narcotics and functional status on postoperative Day 1. Secondary outcomes included operative characteristics, complications, long-term fusion rates, and visual analog scale (VAS) scores.
No statistically significant differences in age, sex, body mass index (BMI), level of disease, or surgical indication were detected between the open TLIF and MITLIF groups. Similarly, preoperative medication usage did not significantly differ between these groups. Intraoperatively, compared with TLIF, MITLIF resulted in decreased lengths of operation, lower blood loss, and fewer complications (p < 0.05). Total administration of morphine-equivalent pain medication in the hospital also tended to be lower in the MITLIF than in the TLIF group. Functional assessment by physical therapy on postoperative Day 1 demonstrated higher function in the MITLIF patients for transfer-related tasks, ambulatory ability, and distance walked than in the TLIF patients (p < 0.05). This translated to shorter inpatient hospitalizations (6.05 vs 4.8 days for open TLIF vs MITLIF patients, respectively, p = 0.006) and an average cost reduction of $3885 per MITLIF patient. Long-term fusion rates were 92% in the MITLIF group and 100% in the open TLIF group (p = 0.09). Preoperative VAS pain scores were 7.1 for the MITLIF patients and 7.6 for the TLIF patients (p = 0.26). At the last follow-up, the reported VAS pain score was 2.9 in the MITLIF patients and 3.5 in the open TLIF patients, but this difference was not statistically significant (p = 0.25). There was also no statistically significant difference in the degree change in this score (p = 0.44).
The MITLIF approach achieves improved functional mobility, decreases the usage of postoperative pain medication, and significantly reduces cost compared with open TLIF while preserving long-term fusion rates. To the authors' knowledge, this is the first study comparing the postoperative usage of pain medication between treatments in the postoperative period before discharge.
先前比较微创经椎间孔腰椎体间融合术（MITLIF）与开放 TLIF 的研究表明，MITLIF 可减少出血量，减轻术后疼痛，同时保持融合率并降低并发症发生率。在本研究中，作者旨在比较 MITLIF 与开放 TLIF 的结果，以确定 MITLIF 是否也能改善术后功能活动能力并减少止痛药的使用。
2006 年至 2011 年期间，共有 75 例连续患者在加利福尼亚大学旧金山分校接受单节段开放 TLIF 或 MITLIF 治疗，平均随访 5.05 年。50 例患者接受 MITLIF 治疗，25 例患者接受开放 TLIF 治疗。主要结局包括术后第 1 天吗啡等效麻醉药的使用和功能状态。次要结局包括手术特点、并发症、长期融合率和视觉模拟量表（VAS）评分。
在开放 TLIF 和 MITLIF 组之间未发现年龄、性别、体重指数（BMI）、疾病程度或手术指征存在统计学差异。同样，术前用药在这些组之间也没有显著差异。与 TLIF 相比，MITLIF 术中手术时间更短，出血量更少，并发症更少（p < 0.05）。MITLIF 组患者在住院期间吗啡等效止痛药的总用量也趋于较低。术后第 1 天物理治疗的功能评估显示，MITLIF 患者在转移相关任务、步行能力和行走距离方面的功能高于 TLIF 患者（p < 0.05）。这导致住院时间缩短（开放 TLIF 组为 6.05 天，MITLIF 组为 4.8 天，p = 0.006），每位 MITLIF 患者的平均成本降低 3885 美元。MITLIF 组的长期融合率为 92%，开放 TLIF 组为 100%（p = 0.09）。MITLIF 组患者术前 VAS 疼痛评分为 7.1，TLIF 组患者为 7.6（p = 0.26）。在最后一次随访时，MITLIF 组患者报告的 VAS 疼痛评分为 2.9，开放 TLIF 组患者为 3.5，但差异无统计学意义（p = 0.25）。该评分的变化程度也无统计学差异（p = 0.44）。
与开放 TLIF 相比，MITLIF 可实现更好的功能活动能力，减少术后止痛药的使用，并显著降低成本，同时保持长期融合率。据作者所知，这是第一项在出院前的术后期间比较两种治疗方法术后止痛药使用情况的研究。
