Bin Abd Razak Hamid Rahmatullah, Dhoke Priyesh, Tay Kae-Sian, Yeo William, Yue Wai-Mun
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Shanta Spine Institute, Nagpur, India.
Asian Spine J. 2017 Apr;11(2):204-212. doi: 10.4184/asj.2017.11.2.204. Epub 2017 Apr 12.
Retrospective review of prospective registry data.
To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.
MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.
The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.
Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.
Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.
对前瞻性登记数据进行回顾性分析。
确定因腰椎滑脱继发神经症状的患者接受单节段器械辅助微创经椎间孔腰椎椎间融合术（MIS-TLIF）后的5年临床和影像学结果。
MIS-TLIF和开放手术方法已显示出可比的结果。这是第一项使用最小临床重要差异（MCID）标准评估MIS-TLIF结果的研究。
前瞻性收集由单一外科医生治疗的56例患者的结果，包括Oswestry功能障碍指数（ODI）、神经症状评分、简短36项问卷（SF-36）以及背痛（BP）和腿痛（LP）的视觉模拟量表（VAS）评分，随访时间长达术后5年。影像学结果包括相邻节段退变、融合、椎间融合器下沉和螺钉松动率。
我们的患者以女性为主（71.4%），平均年龄为53.7±11.3岁，平均体重指数为25.7±3.7kg/m。平均手术时间、失血量、下床活动时间和住院时间分别为167±49分钟、126±107mL、1.2±0.4天和2.8±1.1天。平均透视时间为58.4±33秒，术后平均静脉注射吗啡剂量为8±2mg。关于结果，术后评分相对于术前评分有所改善，并且在长达5年的不同时间点均保持这一趋势（<0.001）。ODI、SF-36、VAS-BP和VAS-LP的改善均符合MCID标准。值得注意的是，我们的患者中有5.4%在随访期间出现了具有临床意义的相邻节段疾病，报告了7例轻微并发症。
单节段器械辅助MIS-TLIF适用于因腰椎滑脱继发神经症状的患者，且并发症发生率可接受。临床和影像学结果在术后长达5年时均保持良好，许多患者达到了MCID。
