Min Sang-Hyuk, Yoo Jae-Sung, Lee Jun-Yeul
Department of Othopedic Surgery, Dankook University College of Medicine, Cheonan, Korea.
Asian Spine J. 2014 Aug;8(4):453-61. doi: 10.4184/asj.2014.8.4.453. Epub 2014 Aug 19.
Retrospective study.
This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF).
Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach.
The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively.
Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p<0.05). On the other hand, no significant difference was found in VAS, ODI, disc height, lordosis angles and the degree of nerve decompression in the vertebral foramen, using MRI, between the two groups (p>0.05).
Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss.
回顾性研究。
本研究旨在探讨通过微创单侧经椎间孔腰椎椎间融合术(MI-TLIF)进行对侧间接减压的临床和影像学结果。
多项研究提出,通过单侧入路可减少失血和手术时间,尽管许多外科医生预测,通过单侧入路难以实现令人满意的椎间孔减压。
该研究纳入了30例行单节段MI-TLIF的受试者。采用视觉模拟量表(VAS)和Oswestry功能障碍指数(ODI)进行临床评估。通过测量椎间盘高度、节段性前凸和腰椎前凸角进行影像学评估。通过术前和术后一年的磁共振成像(MRI)对比分析评估对侧间接减压程度。
单侧入路组(UAP)术中失血量为308.75 mL,双侧入路组(BAP)为575.00 mL,差异有统计学意义。UAP组手术时间为139.50分钟,BAP组为189.00分钟,差异有统计学意义(p<0.05)。另一方面,两组在VAS、ODI、椎间盘高度、前凸角以及使用MRI评估的椎间孔神经减压程度方面,差异无统计学意义(p>0.05)。
通过对侧间接减压的单侧入路进行MI-TLIF可获得与双侧入路相当的满意结果。因此,对侧间接减压被认为是减少手术时间和失血量的有效方法。