Lackey Alan, Phan Kevin, Mobbs Ralph
Brizbrain and Spine, The Wesley Hospital, Evan Thomson Building, Suite 20, Level 10, Chasely Street, Auchenflower, QLD 4066, Australia.
NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia; University of New South Wales, Sydney, NSW, Australia.
J Clin Neurosci. 2016 Dec;34:23-29. doi: 10.1016/j.jocn.2016.06.011. Epub 2016 Jul 27.
A systematic review and meta-analysis was performed to assess the effect of hybrid constructs which involve a total disc arthroplasty (TDA) with stand-alone anterior lumbar interbody fusion (ALIF) versus non-hybrid constructs including multi-level TDA, multi-level transforaminal lumbar interbody fusion (TLIF) with posterior transpedicular fixation or multi-level stand-alone ALIF as a surgical intervention for degenerative disc disease (DDD) in the lumbar spine. Primary outcomes analysed included the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back pain. A systematic search of Medline, Embase, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar was undertaken by two separate reviewers and a meta-analysis of the outcomes was performed. Three studies met our search criteria. When comparing hybrid constructs to multi-level TDA or lumbar fusion (LF) improvements in back pain were found with a VAS back pain score reduction of 1.38 (P<0.00001) postoperatively and a VAS back pain score reduction of 0.99 points (P=0.0006) at 2-years follow-up. Results so far slightly favour clinically significant improved VAS back pain score outcomes postoperatively and at 2-years follow-up for hybrid constructs in multi-level lumbar DDD of the spine when compared with non-hybrid multi-level LF or TDA. It cannot however be concluded that a hybrid construct is superior to multi-level LF or TDA based on this meta-analysis. The results highlight the need for further prospective studies to delineate best practice in the management of degenerative disc disease of the lumbar spine.
进行了一项系统评价和荟萃分析，以评估涉及全椎间盘置换术（TDA）联合独立前路腰椎椎间融合术（ALIF）的混合结构与非混合结构（包括多级TDA、带后路椎弓根固定的多级经椎间孔腰椎椎间融合术（TLIF）或多级独立ALIF）作为腰椎退行性椎间盘疾病（DDD）手术干预措施的效果。分析的主要结局包括Oswestry功能障碍指数（ODI）和背痛视觉模拟量表（VAS）。由两名独立的审阅者对Medline、Embase、Pubmed、Cochrane对照试验中央登记册、Cochrane系统评价数据库和谷歌学术进行了系统检索，并对结局进行了荟萃分析。三项研究符合我们的检索标准。将混合结构与多级TDA或腰椎融合术（LF）进行比较时，发现术后背痛有所改善，VAS背痛评分降低1.38（P<0.00001），在2年随访时VAS背痛评分降低0.99分（P=0.0006）。与非混合多级LF或TDA相比，目前的结果在一定程度上有利于混合结构在多级腰椎DDD患者术后和2年随访时获得临床上显著改善的VAS背痛评分结局。然而，基于这项荟萃分析，不能得出混合结构优于多级LF或TDA的结论。结果强调需要进一步的前瞻性研究来明确腰椎退行性椎间盘疾病管理的最佳实践。
