Kim Ho-Joong, Jeong Jin-Hwa, Cho Hyeon-Guk, Chang Bong-Soon, Lee Choon-Ki, Yeom Jin S
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-Gu, Sungnam, 463-707, Republic of Korea.
Eur Spine J. 2015 Feb;24(2):388-95. doi: 10.1007/s00586-014-3592-4. Epub 2014 Sep 25.
There is no comparative study regarding surgical outcomes between microsurgical extraforaminal decompression (MeFD) and posterior lumbar interbody fusion (PLIF) for the treatment of lumbar foraminal stenosis (LFS). Therefore, the purpose of this study was to compare the surgical outcomes of LFS using two different techniques: MeFD alone or PLIF.
For the purposes of this study, a prospectively collected observational cohort study was conducted. Fifty-five patients diagnosed with LFS who were scheduled to undergo spinal surgery were included in this study. According to the chosen surgical technique, patients were assigned to either the MeFD group (n = 25) or the PLIF group (n = 30). The primary outcome was Oswestry Disability Index (ODI) score at 1 year after surgery.
The baseline patient characteristics and preoperative ODI score, visual analog scale (VAS) scores for back and leg pain, and Short Form-36 score were not significantly different between the two groups. At 12 months postoperative, the mean ODI score in the MeFD and PLIF groups was 25.68 ± 14.49 and 27.20 ± 12.56, respectively, and the 95% confidence interval (-9.76-6.73) was within the predetermined margin of equivalence. The overall ODI score and VAS scores for back and leg pain did not differ significantly over the follow-up assessment time between the two groups. However, the ODI score and VAS scores for back and leg pain improved significantly over time after surgery in both groups. In the MeFD group, revision surgery was required in three patients (12%).
This study demonstrated that MeFD alone and PLIF have equivalent outcomes regarding improvement in disability at 1 year after surgery. However, the higher rate of revision surgery in the MeFD group should emphasize the technically optimal amount of decompression.
对于治疗腰椎管狭窄症（LFS），目前尚无关于显微外科椎间孔外减压术（MeFD）与后路腰椎椎间融合术（PLIF）手术效果的比较研究。因此，本研究的目的是比较采用两种不同技术（单纯MeFD或PLIF）治疗LFS的手术效果。
为进行本研究，开展了一项前瞻性收集的观察性队列研究。本研究纳入了55例诊断为LFS且计划接受脊柱手术的患者。根据所选手术技术，患者被分为MeFD组（n = 25）或PLIF组（n = 30）。主要结局指标为术后1年的Oswestry功能障碍指数（ODI）评分。
两组患者的基线特征、术前ODI评分、背部和腿部疼痛的视觉模拟量表（VAS）评分以及简明健康状况调查简表（Short Form-36）评分无显著差异。术后12个月，MeFD组和PLIF组的平均ODI评分分别为25.68±14.49和27.20±12.56，95%置信区间（-9.76 - 6.73）在预定的等效范围内。在随访评估期间，两组的总体ODI评分以及背部和腿部疼痛的VAS评分无显著差异。然而，两组术后随着时间推移，ODI评分以及背部和腿部疼痛的VAS评分均显著改善。在MeFD组，有3例患者（12%）需要进行翻修手术。
本研究表明，单纯MeFD和PLIF在术后1年改善功能障碍方面效果相当。然而，MeFD组较高的翻修手术率应强调减压技术上的最佳量。
