Udby Peter M, Bech-Azeddine Rachid
Center of Rheumatology and Spine Diseases, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark.
Clin Neurol Neurosurg. 2015 Jun;133:64-9. doi: 10.1016/j.clineuro.2015.03.008. Epub 2015 Mar 16.
The objective of the article was to: a) present results from a case cohort pilot study comparing stand-alone ALIF and TLIF and, b) review the literature on studies comparing the clinical outcome of stand-alone ALIF with posterior instrumentation including TLIF or PLIF, in patients with disabling low back pain resulting from degenerative disc disease. ALIF surgery has previously been linked with certain high risk complications and unfavorable long term fusion results. Newer studies suggest that stand-alone ALIF can possibly be advantageous compared to other types of posterior instrumented interbody fusion for a selected group of DDD patients. The methods and material consisted of a cohort pilot study of patients, with DDD treated with stand-alone ALIF or TLIF followed by a literature review conducted through a comprehensive PubMed database search of the English literature. Studies comparing stand-alone ALIF with posterior instrumented interbody fusion were selected and reviewed. Results from the pilot study, n = 21, showed a reduced perioperative blood loss, shorter operative time and a trend towards better pain reduction and decreased use of opioid analgesics in patients undergoing stand-alone ALIF compared to posterior instrumented fusion with TLIF. The literature review included three studies, n = 630. All three studies were retrospective cohort studies. The average patient follow-up was 2-years but with heterogeneous selected outcomes. Two of three articles documented significant advantages when using stand-alone ALIF on outcomes such as ODI, VAS, surgical time, blood loss and patient satisfaction. No study found stand-alone ALIF inferior in chosen outcomes including fusion. In conclusion the pilot study and the literature review, finds similar clinical outcomes and fusion rates after stand-alone ALIF and posterior interbody fusion. Stand-alone ALIF was associated with a shorter duration of surgery, less perioperative blood loss and a faster improvement post-operatively. Therefore stand-alone ALIF is a viable and important surgical option, which could be considered first choice as surgical treatment.
a）展示一项病例队列试点研究的结果，该研究比较了单纯前路腰椎椎间融合术（ALIF）和经椎间孔腰椎椎间融合术（TLIF）；b）回顾关于比较单纯ALIF与包括TLIF或后路腰椎椎间融合术（PLIF）在内的后路内固定术治疗因椎间盘退变导致的致残性腰痛患者的临床结果的文献。此前，ALIF手术与某些高风险并发症及不良的长期融合结果相关。最新研究表明，对于特定的一组椎间盘退变疾病（DDD）患者，单纯ALIF可能比其他类型的后路内固定椎间融合术更具优势。方法和材料包括一项对接受单纯ALIF或TLIF治疗的DDD患者的队列试点研究，随后通过对英文文献进行全面的PubMed数据库检索进行文献综述。选择并回顾了比较单纯ALIF与后路内固定椎间融合术的研究。试点研究结果（n = 21）显示，与TLIF后路内固定融合术相比，接受单纯ALIF的患者围手术期失血量减少、手术时间缩短，且在疼痛减轻和阿片类镇痛药使用减少方面有更好的趋势。文献综述纳入了三项研究（n = 630）。所有三项研究均为回顾性队列研究。患者平均随访时间为2年，但所选结果存在异质性。三篇文章中有两篇记录了在使用单纯ALIF时，在诸如功能障碍指数（ODI）、视觉模拟评分（VAS）、手术时间、失血量和患者满意度等结果方面有显著优势。没有研究发现单纯ALIF在包括融合在内的所选结果方面较差。总之，试点研究和文献综述发现，单纯ALIF和后路椎间融合术后的临床结果和融合率相似。单纯ALIF与手术时间缩短、围手术期失血量减少及术后更快恢复相关。因此，单纯ALIF是一种可行且重要的手术选择，可被视为手术治疗的首选。
