Teng Ian, Han Julian, Phan Kevin, Mobbs Ralph
Faculty of Medicine, The University of New South Wales (UNSW), Sydney, NSW, Australia.
Faculty of Medicine, The University of New South Wales (UNSW), Sydney, NSW, Australia.
J Clin Neurosci. 2017 Oct;44:11-17. doi: 10.1016/j.jocn.2017.06.013. Epub 2017 Jul 1.
Lumbar interbody fusions have been widely used to treat degenerative lumbar disease that fails to respond to conservative treatment. This procedure is divided according to its approach: anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF). Each approach has its own theoretical advantages and disadvantages; however, there have been no studies that compared these.
Various full-text databases were systematically searched through December 2015. Data regarding the radiological, operative and clinical outcomes of each lumbar interbody fusion were extracted. All outcomes were pooled using random effects meta-analysis, with the relative risk (RR) and/or weighted mean difference (WMD) as the summary statistic.
Thirty studies met the inclusion criteria. The ALIF procedure has been studied most intensively, followed by PLIF, TLIF and LLIF respectively. All four approaches had similar fusion rates (p=0.320 & 0.703). ALIF has superior radiological outcome, achieving better postoperative disc height (p=0.002 & 0.005) and postoperative segmental lordosis (p=0.013 & 0.000). TLIF had better Oswestry Disability Index scores (p=0.025 & 0.000) while PLIF had the greatest blood loss (p=0.032 & 0.006). Complication rates were similar between approaches. Other comparisons were either inconclusive or lacked data. There was marked less studies comparing against LLIF.
Each approach has their own risks and benefits but similar fusion rates. Despite the large number of studies, there is little data overall when comparing specific aspects of lumbar interbody fusions. More studies, especially RCTs are needed to further explore this topic.
腰椎椎间融合术已被广泛用于治疗对保守治疗无反应的退行性腰椎疾病。该手术根据其入路可分为：前路腰椎椎间融合术（ALIF）、后路腰椎椎间融合术（PLIF）、经椎间孔腰椎椎间融合术（TLIF）和侧方腰椎椎间融合术（LLIF）。每种入路都有其理论上的优缺点；然而，尚无比较这些入路的研究。
系统检索了截至2015年12月的各种全文数据库。提取了每种腰椎椎间融合术的放射学、手术和临床结果的数据。所有结果均采用随机效应荟萃分析进行汇总，以相对风险（RR）和/或加权平均差（WMD）作为汇总统计量。
30项研究符合纳入标准。对ALIF手术的研究最为深入，其次分别是PLIF、TLIF和LLIF。所有四种入路的融合率相似（p = 0.320和0.703）。ALIF具有更好的放射学结果，术后椎间盘高度更佳（p = 0.002和0.005），术后节段性前凸更好（p = 0.013和0.000）。TLIF的Oswestry功能障碍指数评分更好（p = 0.025和0.000），而PLIF的失血量最大（p = 0.032和0.006）。各入路之间的并发症发生率相似。其他比较要么无定论，要么缺乏数据。与LLIF比较的研究明显较少。
每种入路都有其自身的风险和益处，但融合率相似。尽管有大量研究，但在比较腰椎椎间融合术的具体方面时，总体数据较少。需要更多研究，尤其是随机对照试验，以进一步探索该主题。
