Sembrano Jonathan N, Tohmeh Antoine, Isaacs Robert
*University of Minnesota, Minneapolis, Minnesota †Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota ‡Northwest Orthopedic Specialists, Spokane, Washington §Department of Neurosurgery, Duke University, Durham, North Carolina.
Spine (Phila Pa 1976). 2016 Apr;41 Suppl 8:S123-32. doi: 10.1097/BRS.0000000000001471.
A prospective, multicenter, institutional review board (IRB) approved study with randomized and observational study arms.
The purpose of this study was to compare clinical outcomes between minimally invasive transforaminal (MIS TLIF) and MIS lateral interbody fusion (XLIF) in the treatment of patients with low-grade degenerative spondylolisthesis with stenosis through two years postoperative.
Few reports exist comparing different MIS approaches directly in the treatment of similar pathology, as most studies report differences between MIS and open procedures.
A total of 55 patients undergoing surgical treatment for degenerative spondylolisthesis with spinal stenosis at one or two contiguous levels between L1 and L5 were enrolled. Twenty-nine patients were treated with XLIF and 26 patients were treated with MIS TLIF.
Operative time and length of stay were similar between the XLIF and MIS TLIF groups (171 vs 186 minutes; two days for each group). Blood loss was significantly lower in the XLIF group, with 79% of XLIF cases and 27% of MIS TLIF cases resulting in <100 mL of blood loss, P < 0.001. Hip flexion weakness was more common in the XLIF group (31%) than in the MIS TLIF group (0%). One patient in the XLIF group had a new distal motor weakness and three patients in the XLIF group and two patients in the MIS TLIF group had new sensory changes postoperatively, all of which resolved by 12 months postoperative. Back and leg pain for both XLIF and MIS TLIF groups improved significantly from baseline to 24 months postoperative, with 73% improvement in the XLIF and 64% in the MIS TLIF group. Worst leg pain showed similar improvements through two years postoperative, with a 79% decrease seen in the XLIF group and 74% in the MIS TLIF group. Disability (ODI) improved 53% in the XLIF group and 57% in the MIS TLIF group.
Despite different mechanisms of action (indirect vs direct decompression), mid-term clinical outcomes between XLIF and MIS TLIF were similar. These two-year results suggest that both XLIF and MIS TLIF are reasonable MIS approaches for the treatment of lumbar degenerative pathology.
一项前瞻性、多中心、经机构审查委员会（IRB）批准的研究，设有随机和观察性研究组。
本研究的目的是比较微创经椎间孔（MIS TLIF）和微创外侧椎间融合术（XLIF）在治疗伴有椎管狭窄的低度退行性椎体滑脱患者术后两年的临床疗效。
很少有报告直接比较不同的微创方法治疗相似病理情况的效果，因为大多数研究报告的是微创与开放手术之间的差异。
共有55例在L1至L5之间一个或两个连续节段接受退行性椎体滑脱伴椎管狭窄手术治疗的患者入组。29例患者接受XLIF治疗，26例患者接受MIS TLIF治疗。
XLIF组和MIS TLIF组的手术时间和住院时间相似（分别为171分钟和186分钟；每组均为两天）。XLIF组的失血量显著更低，79%的XLIF病例和27%的MIS TLIF病例失血量<100 mL，P<0.001。XLIF组髋部屈曲无力比MIS TLIF组更常见（31%比0%）。XLIF组有1例患者出现新的远端运动无力，XLIF组有3例患者和MIS TLIF组有2例患者术后出现新的感觉改变，所有这些在术后12个月时均得到缓解。XLIF组和MIS TLIF组的腰腿痛从基线到术后24个月均有显著改善，XLIF组改善73%，MIS TLIF组改善64%。至术后两年，最严重腿痛的改善情况相似，XLIF组下降79%，MIS TLIF组下降74%。XLIF组的功能障碍（ODI）改善53%，MIS TLIF组改善57%。
尽管作用机制不同（间接减压与直接减压），但XLIF和MIS TLIF的中期临床疗效相似。这两年的结果表明，XLIF和MIS TLIF都是治疗腰椎退行性病变合理的微创方法。
2级。
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