Ghasemi Amir Abbas
Neurosurgery Department, Urmia Medical University, Ershad Blvd, Imam Khomeini Hospital, Urmia, Iran.
Clin Neurol Neurosurg. 2016 Nov;150:1-5. doi: 10.1016/j.clineuro.2016.08.017. Epub 2016 Aug 21.
Various surgical procedures have been recommended for the treatment of degenerative spondylolisthesis,but Controversy still exists regarding the optimal surgical technique . In this study,we compared the clinical and radiologic outcome of the Transforaminal lumbar interbody fusion(TLIF) method with the Instrumented Posterolateral fusion(PLF) in these patients.
The study population in this retrospective study consisted of 145 consecutive patients of degenerative spondylolisthesis who had undergone lumbar fusion in our institute between September 2010 and October 2013. The patients were divided into two treatment groups, where either instrumented PLF with pedicle screw(180° fusion) or TLIF procedure(360° fusion) was done. The follow-up was performed clinically using the Oswestry Disability Index (ODI), visual analogue scale (VAS)and global outcome. Outcome scores were assessed at 3, 6, 12, and 24 months after surgery. Radiographs were obtained postoperatively and at regular intervals for 24 months. Perioperative outcomes such as surgery time, blood loss, length of hospital stay and incidence of surgical complications were also recorded.
80 patients underwent TLIF procedure and 65 patients were included in the instrumented PLF group. There were no significant differences between the groups with respect to age,gender,Body Mass Index,smoking and comorbid conditions(p>0.05). No significant difference existed in Pre-operative VAS for back pain,VAS for leg pain and ODI between the two groups(p>0.05). There were no significant group differences in the operation level,hospital stay and surgical complications(all p>0.05). Blood loss, operation time and fusion success rate were significantly greater in the TLIF group than in the PLF group (all P<0.05). Significant differences between groups concerning VAS for back pain,ODI and Global outcome were present at final follow-up. There was no significant difference between the two groups with respect to VAS for leg pain.
Our study showed that TLIF is superior to PLF with respect to functional outcome and fusion rate.
已推荐多种外科手术治疗退变性腰椎滑脱症，但关于最佳手术技术仍存在争议。在本研究中，我们比较了经椎间孔腰椎椎间融合术（TLIF）与器械辅助后外侧融合术（PLF）治疗这些患者的临床和影像学结果。
本回顾性研究的研究对象为2010年9月至2013年10月间在我院接受腰椎融合术的145例连续性退变性腰椎滑脱症患者。患者被分为两个治疗组，分别接受器械辅助经椎弓根螺钉的PLF术（180°融合）或TLIF手术（360°融合）。采用Oswestry功能障碍指数（ODI）、视觉模拟评分法（VAS）和整体疗效进行临床随访。在术后3、6、12和24个月评估疗效评分。术后及术后24个月定期拍摄X线片。还记录了手术时间、失血量、住院时间和手术并发症发生率等围手术期结果。
80例患者接受了TLIF手术，65例患者纳入器械辅助PLF组。两组在年龄、性别、体重指数、吸烟情况和合并症方面无显著差异（p>0.05）。两组术前背痛VAS、腿痛VAS和ODI无显著差异（p>0.05）。手术节段、住院时间和手术并发症在两组间无显著差异（均p>0.05）。TLIF组的失血量、手术时间和融合成功率显著高于PLF组（均P<0.05）。末次随访时，两组在背痛VAS、ODI和整体疗效方面存在显著差异。两组在腿痛VAS方面无显著差异。
我们的研究表明，TLIF在功能结局和融合率方面优于PLF。
