Keorochana Gun, Setrkraising Kitipong, Woratanarat Patarawan, Arirachakaran Alisara, Kongtharvonskul Jatupon
Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Neurosurg Rev. 2018 Jul;41(3):755-770. doi: 10.1007/s10143-016-0806-8. Epub 2016 Dec 24.
The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.
用于治疗退行性腰椎疾病的腰椎关节融合术所采用的外科手术方法仍存在争议。本系统评价旨在评估和比较每种技术（微创经椎间孔腰椎椎间融合术（MIS-TLIF）或微创外侧腰椎椎间融合术（MIS LLIF））治疗退行性腰椎疾病的临床疗效、并发症及融合情况。从Medline和Scopus数据库中检索自建库起至2016年7月19日期间发表的相关研究，这些研究报告了Oswestry功能障碍指数（ODI）、腰腿痛视觉模拟评分（VAS）、术后并发症以及两种技术的融合情况。纳入58项研究用于分析MIS-TLIF；纳入40项研究用于分析LLIF，并纳入1项随机对照试验（RCT）研究用于比较MIS-TLIF与LLIF。总体而言，共有9506例患者（MIS-TLIF组5728例，LLIF组3778例）。间接荟萃分析显示，与LLIF技术相比，MIS-TLIF术后腰腿痛（VAS）、功能障碍（ODI）及并发症风险更低，但两种技术的融合率无显著差异。然而，RCT研究与MIS-TLIF汇总间接荟萃分析之间的直接荟萃分析显示，与LLIF相比，MIS-TLIF在疼痛、功能障碍及并发症方面表现更好，但差异无统计学意义。在LLIF中，MIS入路的汇总平均ODI和VAS腰背痛分别为2.91（95%CI 2.49，3.33）和23.24（95%CI 18.96，27.51），而传统入路分别为3.14（95%CI 2.29，4.04）和28.29（95%CI 21.92，34.67）。在并发症和融合率方面，两组无差异。在腰椎椎间融合术中，采用直接和间接荟萃分析方法时，与LLIF相比，MIS-TLIF的ODI、VAS疼痛及并发症发生率更低。然而，在融合率方面，两种技术无差异。
