Safaee Michael M, Oh Taemin, Pekmezci Murat, Clark Aaron J
Department of Neurological Surgery, University of California, San Francisco, United States.
Department of Orthopaedic Surgery, University of California, San Francisco, United States.
J Clin Neurosci. 2018 Feb;48:122-127. doi: 10.1016/j.jocn.2017.09.026. Epub 2017 Nov 11.
The transforaminal lumbar interbody fusion (TLIF) is used for the treatment of back and leg pain secondary to spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) is associated with less estimated blood loss (EBL), decreased length of stay, lower infection rates, and similar outcomes compared to the traditional TLIF. Fluoroscopy time has been reported with MIS-TLIF, but there are limited data on specific radiation dosages. We performed a retrospective analysis of a prospectively acquired cohort of patients undergoing MIS-TLIF. A total of 50 patients were included. Mean age was 53 years with 60% women and mean BMI of 30 (range 21-41). Diagnoses were as follows: 45 stenosis (90%), 29 spondylolisthesis (58%), 5 facet cysts (10%), 3 scoliosis (6%), and 1 cauda equina syndrome (2%). A single level was fused in 33 cases (66%), two levels in 15 (30%), three levels in 2 (4%). Average cage height was 10 mm with mean EBL of 80 ml and operative time of 240 min. The average radiation doses from intraoperative CT scan and fluoroscopy were 35.3 and 26.5 mGy, respectively. Average CT scan and fluoroscopy times were 5.2 and 37.1 s, respectively, for a total of 42.2 s. Average length of stay was 3 days (range 1-7 days). Although these data represent a preliminary experience, by streamlining the timing of intraoperative CT scan and minimizing the amount of intraoperative fluoroscopy, this protocol has the potential for decreasing operative time and radiation exposure.
经椎间孔腰椎椎体间融合术（TLIF）用于治疗继发于椎管狭窄、椎间盘退变疾病和椎体滑脱的腰腿痛。与传统TLIF相比，微创手术（MIS）的估计失血量（EBL）更少、住院时间缩短、感染率降低且疗效相似。已有关于MIS-TLIF的透视时间报道，但关于具体辐射剂量的数据有限。我们对一组前瞻性收集的接受MIS-TLIF的患者队列进行了回顾性分析。共纳入50例患者。平均年龄为53岁，女性占60%，平均体重指数为30（范围21 - 41）。诊断如下：45例椎管狭窄（90%）、29例椎体滑脱（58%）、5例关节突囊肿（10%）、3例脊柱侧弯（6%）和1例马尾神经综合征（2%）。33例（66%）为单节段融合，15例（30%）为双节段融合，2例（4%）为三节段融合。平均椎间融合器高度为10毫米，平均EBL为80毫升，手术时间为240分钟。术中CT扫描和透视的平均辐射剂量分别为35.3和26.5毫戈瑞。平均CT扫描和透视时间分别为5.2秒和37.1秒，总计42.2秒。平均住院时间为3天（范围1 - 7天）。尽管这些数据代表了初步经验，但通过优化术中CT扫描时间并减少术中透视量，该方案有可能减少手术时间和辐射暴露。
