McAnany Steven J, Overley Samuel C, Anwar Muhammad A, Cutler Holt S, Guzman Javier Z, Kim Jun S, Merrill Robert K, Cho Samuel K, Hecht Andrew C, Qureshi Sheeraz A
Washington University, St Louis, MO, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Global Spine J. 2018 Feb;8(1):11-16. doi: 10.1177/2192568217718818. Epub 2017 Sep 22.
Retrospective cohort study.
To determine the incidence of index level fusion following open or minimally invasive lumbar microdiscectomy.
We conducted a retrospective review of 174 patients with a symptomatic single-level lumbar herniated nucleus pulposus who underwent microdiscectomy via a mini-open approach (MIS; 39) or through a minimally invasive dilator tube (135). Outcomes of interest included revision microdiscectomy and the ultimate need for index level fusion. Continuous variables were analyzed with independent sample test, and χ analysis was used for categorical data. A multivariate regression analysis was performed to identify predictive factors for patients that required index level fusion after lumbar microdiscectomy.
There was no difference in patient demographics in the open and MIS groups aside from length of follow-up (60.4 vs 40.03 months, < .0001) and body mass index (24.72 vs 27.21, = .03). The rate of revision microdiscectomy was not statistically significant between open and MIS approaches (10.3% vs 10.4%, = .90). The rate of patients who ultimately required index level fusion approached significance, but was not statistically different between open and MIS approaches (10.3% vs 4.4%, = .17). Multivariate regression analysis indicated that the need for eventual index level fusion after lumbar microdiscectomy was statistically predicted in smokers and those patients who underwent revision microdiscectomy ( < .05) in both open and MIS groups.
Our results suggest a low likelihood of patients ultimately requiring fusion following microdiscectomy with predictors including smoking status and a history of revision microdiscectomy.
回顾性队列研究。
确定开放性或微创腰椎间盘显微切除术术后索引节段融合的发生率。
我们对174例有症状的单节段腰椎间盘突出症患者进行了回顾性研究，这些患者通过迷你开放入路（MIS；39例）或微创扩张管（135例）接受了显微椎间盘切除术。感兴趣的结果包括翻修显微椎间盘切除术以及最终是否需要索引节段融合。连续变量采用独立样本检验进行分析，分类数据采用χ分析。进行多因素回归分析以确定腰椎显微椎间盘切除术后需要索引节段融合的患者的预测因素。
除随访时间（60.4个月对40.03个月，P<0.0001）和体重指数（24.72对27.21，P = 0.03）外，开放组和MIS组患者的人口统计学特征无差异。开放入路和MIS入路之间翻修显微椎间盘切除术的发生率无统计学意义（10.3%对10.4%，P = 0.90）。最终需要索引节段融合的患者比例接近显著性，但开放入路和MIS入路之间无统计学差异（10.3%对4.4%，P = 0.17）。多因素回归分析表明，在开放组和MIS组中，吸烟者以及接受翻修显微椎间盘切除术的患者在腰椎显微椎间盘切除术后最终需要索引节段融合的情况具有统计学预测意义（P<0.05）。
我们的结果表明，在进行显微椎间盘切除术后，患者最终需要融合的可能性较低，预测因素包括吸烟状况和翻修显微椎间盘切除术史。
