Hari Akshay, Krishna Murali, Rajagandhi Santhosh, Rajakumar Deshpande V
Department of Neurosurgery, Fortis Hospital, Bengaluru, Karnataka, India.
Neurol India. 2016 May-Jun;64(3):444-54. doi: 10.4103/0028-3886.181536.
Transforaminal lumbar interbody fusion (TLIF) has emerged as one of the common procedures performed by spine surgeons. Back pain and radiculopathy due to degenerative disc disease, spondylolisthesis, or deformity are the usual indications. Minimally invasive surgery (MIS) techniques have proven to be effective in TLIF as they are associated with less blood loss, fewer wound complications and infections, faster recovery, and decreased hospital costs. The novel technique described in this study helps to achieve a circumferential lumbar fusion using a unilateral posterior approach, via a muscle-dilating exposure, thereby minimizing the approach-related morbidity.
An overview of the minimally invasive TLIF (MIS-TLIF) procedures including indications, techniques, and clinical experience along with a review of the medical literature is hereby presented.
All patients who underwent MIS-TLIF for various indications at our institution from 2009 to 2014 were retrospectively reviewed. All patients in this series had low back pain as their predominant symptom, with varying degrees of radicular pain and neurologic symptoms. The data collected retrospectively for analysis were age, gender, previous diagnoses, revision diagnosis, duration of symptoms, levels of fusion, operating time, intraoperative blood loss, clinical and radiographic results after surgery, and complications. Back and leg pain quantified by visual analog scale scores preoperatively, postoperatively, and at the last follow-up were assessed for clinical outcomes.
Our clinical experience along with a review of the medical literature indicates that TLIF can be effectively and safely performed in a minimally invasive fashion for a wide variety of indications.
经椎间孔腰椎椎间融合术（TLIF）已成为脊柱外科医生常用的手术之一。由椎间盘退变、椎体滑脱或畸形引起的背痛和神经根病是常见的适应症。微创手术（MIS）技术已被证明在TLIF中有效，因为它们与更少的失血、更少的伤口并发症和感染、更快的恢复以及降低的医院成本相关。本研究中描述的新技术有助于通过肌肉扩张暴露采用单侧后路实现腰椎环形融合，从而将与手术入路相关的发病率降至最低。
本文概述了微创TLIF（MIS-TLIF）手术，包括适应症、技术和临床经验，并对医学文献进行了综述。
对2009年至2014年在我院因各种适应症接受MIS-TLIF手术的所有患者进行回顾性研究。本系列所有患者均以腰痛为主要症状，伴有不同程度的神经根性疼痛和神经症状。回顾性收集用于分析的数据包括年龄、性别、既往诊断、修正诊断、症状持续时间、融合节段、手术时间、术中失血、术后临床和影像学结果以及并发症。通过术前、术后和最后一次随访时的视觉模拟评分对背痛和腿痛进行量化，以评估临床结果。
我们的临床经验以及对医学文献的综述表明，TLIF可以以微创方式有效且安全地用于多种适应症。
