Tian Wei, Xu Yun-Feng, Liu Bo, Liu Ya-Jun, He Da, Yuan Qiang, Lang Zhao, Han Xiao-Guang
*Medical Center, Tsinghua University †Department of Spine Surgery, Beijing Jishuitan Hospital,Beijing, China.
Clin Spine Surg. 2017 Jul;30(6):237-242. doi: 10.1097/BSD.0000000000000165.
This study was a retrospective review of prospectively collected clinical data.
To evaluate the clinical and radiologic outcomes of computer-assisted minimally invasive spine surgery transforaminal lumbar interbody fusion (CAMISS-TLIF) and open TLIF for the treatment of 1-level degenerative lumbar disease.
Minimally invasive TLIF is becoming increasingly popular; however, the limited space and high rate of hardware complications associated with this method are challenging to surgeons. Computer-assisted navigation has the potential to dynamically show the fine anatomic structures, which could theoretically facilitate minimally invasive spine procedures.
Sixty-one patients underwent 1-level TLIF procedures (30, CAMISS-TLIF; 31, open TLIF). The computer-assisted navigation system was used for CAMISS-TLIF, whereas conventional fluoroscopy was used for open TLIF. Demographic, operative, visual analog scale, and Oswestry disability index data were collected. Screw insertion was assessed by computed tomography, and radiologic fusion based on Bridwell grading was evaluated 2 years after surgery by independent investigators.
The CAMISS-TLIF group had significantly less blood loss, postoperative drain, need for transfusion, and initial postoperative back pain; earlier rehabilitation; and shorter postoperative hospitalization than the open TLIF group, whereas CAMISS-TLIF took longer surgical time than open TLIF. However, no significant differences between the 2 groups in visual analog scale scores and Oswestry disability index were observed at 3 months, 1 year, and 2 years postoperatively. A total of 93.33% and 73.39% of screws in the CAMISS and open groups, respectively, had no pedicle perforation (P=0.016), and the fusion rate was similar in both groups (P=0.787).
Computer-assisted navigation facilitated minimally invasive spine surgery-TLIF. CAMISS-TLIF was superior to open TLIF for treating 1-level degenerative lumbar disease, although it required longer operation time in the initial stage. CAMISS-TLIF showed several benefits compared with open TLIF, including less intraoperative blood loss, postoperative drainage, and pain; earlier rehabilitation; and shorter postoperative hospitalization.
本研究是对前瞻性收集的临床数据进行回顾性分析。
评估计算机辅助微创脊柱手术经椎间孔腰椎椎体间融合术（CAMISS-TLIF）与开放TLIF治疗单节段退变性腰椎疾病的临床及影像学结果。
微创TLIF越来越受欢迎；然而，该方法相关的空间有限和硬件并发症发生率高给外科医生带来了挑战。计算机辅助导航有可能动态显示精细的解剖结构，从理论上讲，这可以促进微创脊柱手术。
61例患者接受了单节段TLIF手术（30例采用CAMISS-TLIF；31例采用开放TLIF）。计算机辅助导航系统用于CAMISS-TLIF，而开放TLIF采用传统的透视。收集了人口统计学、手术、视觉模拟评分和Oswestry功能障碍指数数据。通过计算机断层扫描评估螺钉置入情况，术后2年由独立研究者根据Bridwell分级评估影像学融合情况。
与开放TLIF组相比，CAMISS-TLIF组术中出血量、术后引流量、输血需求及术后初期背痛明显减少；康复更早；术后住院时间更短，而CAMISS-TLIF的手术时间比开放TLIF长。然而，两组术后3个月、1年和2年的视觉模拟评分和Oswestry功能障碍指数无显著差异。CAMISS组和开放组分别有93.33%和73.39%的螺钉无椎弓根穿孔（P=0.016），两组融合率相似（P=0.787）。
计算机辅助导航促进了微创脊柱手术-TLIF。CAMISS-TLIF在治疗单节段退变性腰椎疾病方面优于开放TLIF，尽管其在初始阶段需要更长的手术时间。与开放TLIF相比，CAMISS-TLIF有几个优点，包括术中出血量少、术后引流少、疼痛轻；康复更早；术后住院时间更短。
