Schöller Karsten, Alimi Marjan, Cong Guang-Ting, Christos Paul, Härtl Roger
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA.
Department of Neurosurgery, Justus-Liebig University, Giessen, Germany.
Neurosurgery. 2017 Mar 1;80(3):355-367. doi: 10.1093/neuros/nyw091.
Decompression without fusion is a treatment option in patients with lumbar spinal stenosis (LSS) associated with stable low-grade degenerative spondylolisthesis (DS). A minimally invasive unilateral laminotomy (MIL) for "over the top" decompression might be a less destabilizing alternative to traditional open laminectomy (OL).
To review secondary fusion rates after open vs minimally invasive decompression surgery.
We performed a literature search in Pubmed/MEDLINE using the keywords "lumbar spondylolisthesis" and "decompression surgery." All studies that separately reported the outcome of patients with LSS+DS that were treated by OL or MIL (transmuscular or subperiosteal route) were included in our systematic review and meta-analysis. The primary end point was secondary fusion rate. Secondary end points were total reoperation rate, postoperative progression of listhetic slip, and patient satisfaction.
We identified 37 studies (19 with OL, 18 with MIL), with a total of 1156 patients, that were published between 1983 and 2015. The studies' evidence was mostly level 3 or 4. Secondary fusion rates were 12.8% after OL and 3.3% after MIL; the total reoperation rates were 16.3% after OL and 5.8% after MIL. In the OL cohort, 72% of the studies reported a slip progression compared to 0% in the MIL cohort, respectively. After OL, satisfactory outcome was 62.7% compared to 76% after MIL.
In patients with LSS and DS, minimally invasive decompression is associated with lower reoperation and fusion rates, less slip progression, and greater patient satisfaction than open surgery.
对于伴有稳定的低度退变性腰椎滑脱（DS）的腰椎管狭窄症（LSS）患者，非融合减压是一种治疗选择。“越过顶部”减压的微创单侧椎板切除术（MIL）可能是比传统开放性椎板切除术（OL）更具稳定性的替代方法。
回顾开放性与微创减压手术后的二次融合率。
我们在Pubmed/MEDLINE中使用关键词“腰椎滑脱”和“减压手术”进行文献检索。所有分别报告了接受OL或MIL（经肌肉或骨膜下途径）治疗的LSS+DS患者结局的研究均纳入我们的系统评价和荟萃分析。主要终点是二次融合率。次要终点是总再手术率、术后滑脱进展情况以及患者满意度。
我们确定了1983年至2015年间发表的37项研究（19项为OL，18项为MIL），共1156例患者。这些研究的证据大多为3级或4级。OL术后二次融合率为12.8%，MIL术后为3.3%；OL术后总再手术率为16.3%，MIL术后为5.8%。在OL队列中，72%的研究报告有滑脱进展，而MIL队列中这一比例为0%。OL术后满意结局为62.7%，而MIL术后为76%。
对于LSS和DS患者，与开放手术相比，微创减压与更低的再手术率和融合率、更少的滑脱进展以及更高的患者满意度相关。
