Kulkarni Arvind G, Bohra Hussain, Dhruv Abhilash, Sarraf Abhishek, Bassi Anupreet, Patil Vishwanath M
Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India.
Indian J Orthop. 2016 Sep;50(5):464-472. doi: 10.4103/0019-5413.189607.
The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF.
All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM SPSS Statistics version 17).
129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower ( < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma.
The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.
本前瞻性研究的目的是评估与开放经椎间孔腰椎椎间融合术（O-TLIF）相比，微创经椎间孔腰椎椎间融合术（MI-TLIF）所宣称的优势是否能转化为更优、相当或更差的治疗效果。这是印度次大陆第一项前瞻性比较MI-TLIF和O-TLIF治疗效果的研究。
对所有连续的开放及MI-TLIF病例进行前瞻性随访。纳入2011年1月至2013年1月间因腰椎峡部裂和退行性病变（退行性腰椎滑脱、中央型椎间盘突出症）而接受单节段TLIF手术的病例。比较两组患者术前及术后的Oswestry功能障碍指数（ODI）、背痛和腿痛的视觉模拟评分（VAS）、住院时间、手术时间、辐射暴露量、定量C反应蛋白（QCRP）及失血量。对这些参数进行统计学分析（使用IBM SPSS Statistics 17版软件）。
在研究期间，129例患者接受了TLIF手术，其中71例患者（46例行MI-TLIF，25例行O-TLIF）符合纳入标准。其中，另有10例患者因数据不足和/或未进行随访而被排除。平均随访时间为36.5个月（范围18 - 54个月）。MI-TLIF病例的住院时间较短（O-TLIF为5.84天±2.249，MI-TLIF为4.11天±1.8，P<0.05）。MI-TLIF病例的失血量较少（开放手术为358.8 ml，MI-TLIF为111.81 ml，P<0.05）。MI组的手术时间较长（O-TLIF为2.96小时±0.57，MI-TLIF为3.40小时±0.54，P<0.05）。MI-TLIF平均需要57.77次透视曝光，显著高于O-TLIF（8.2次）。MI-TLIF组和O-TLIF组在ODI和VAS评分改善方面无统计学显著差异。MI-TLIF组术前及术后QCRP值的变化显著低于O-TLIF组（P<0.000），表明组织创伤较小。
MI-TLIF的治疗效果与O-TLIF相当。MI-TLIF的优势在于失血量较少、住院时间较短、组织创伤较小以及可早期活动。MI-TLIF的挑战在于学习曲线陡峭和辐射暴露量大。TLIF的最终成功在于手术的实施，在这方面，使用微创技术能取得相似结果的能力使MI-TLIF成为一个有吸引力的选择。
