Ng Karen Ka Man, Cheung Jason Pui Yin
1 Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China.
J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017716254. doi: 10.1177/2309499017716254.
The purpose of this study is to review the updated evidence comparing outcomes between minimally invasive surgery (MIS) and conventional open surgery (COS) for lumbar spinal stenosis (LSS).
All randomized controlled trials (RCTs) published from January 2005 to August 2016 were identified through PubMed and MEDLINE databases. Only RCTs including patients with LSS and with direct comparison between COS and MIS were selected for analysis. The intra- and post-operative effects of different MIS and COS on patients with LSS were evaluated for any differences.
We reviewed 10 RCTs comparing the effect of MIS and COS for LSS. Most trials showed that MIS rendered a shorter duration of hospital stay, lower reoperation rate, visual analogue scale (VAS), 36-Item Form Health Survey (SF-36) score, creatinine phosphokinase-skeletal muscle (CPK-MM) levels and a higher Japanese Orthopaedic Association (JOA) score. However, the intergroup differences were not statistically significant for all comparisons and were only present for selected mild cases of spinal stenosis.
This systematic review suggests that MIS reduces operating time, duration of hospital stay and CPK-MM levels. However, the evidence for these parameters is weak. Moreover, there is no conclusive evidence that MIS reduces reoperation or has better improvement in pain and outcome scores like VAS, SF-36 and JOA scores. The evidence is limited due to poor standardization of MIS definition, methodology and details of surgeon experience. MIS techniques should not be studied as a group, as each procedure is vastly different from each other.
本研究旨在回顾比较微创手术（MIS）与传统开放手术（COS）治疗腰椎管狭窄症（LSS）疗效的最新证据。
通过PubMed和MEDLINE数据库检索2005年1月至2016年8月发表的所有随机对照试验（RCT）。仅选择纳入LSS患者且对COS和MIS进行直接比较的RCT进行分析。评估不同MIS和COS对LSS患者的术中和术后影响有无差异。
我们回顾了10项比较MIS和COS治疗LSS疗效的RCT。大多数试验表明，MIS可缩短住院时间、降低再次手术率、降低视觉模拟评分（VAS）、提高36项健康调查简表（SF - 36）评分、降低肌酸磷酸激酶 - 骨骼肌（CPK - MM）水平，并提高日本骨科协会（JOA）评分。然而，所有比较的组间差异均无统计学意义，仅在部分轻度椎管狭窄病例中存在差异。
本系统评价表明，MIS可缩短手术时间、住院时间并降低CPK - MM水平。然而，这些参数的证据较弱。此外，没有确凿证据表明MIS可降低再次手术率或在疼痛及VAS、SF - 36和JOA评分等结局评分方面有更好改善。由于MIS定义、方法和外科医生经验细节的标准化较差，证据有限。不应将MIS技术作为一个整体进行研究，因为每种手术彼此差异很大。
