椎板切除术治疗退行性腰椎疾病/腰椎滑脱的并发症和再次手术率低于微创经椎间孔腰椎椎体间融合术/其他融合术：一项综述。

Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review.

作者信息

Epstein Nancy E

机构信息

Professor of Clinical Neurosurgery, School of Medicine, University of State of New York at Stony Brook, Mineola, New York, USA.

Chief of Neurosurgical Spine/Education, NYU Winthrop Hospital, Mineola, New York, USA.

出版信息

Surg Neurol Int. 2018 Mar 7;9:55. doi: 10.4103/sni.sni_26_18. eCollection 2018.

DOI:10.4103/sni.sni_26_18

PMID:29576906

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5858051/

Abstract

BACKGROUND

Utilizing the spine literature, we compared the complication and reoperation rates for laminectomy alone vs. instrumented fusions including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) for the surgical management of multilevel degenerative lumbar disease with/without degenerative spondylolisthesis (DS).

METHODS

Epstein compared complication and reoperation rates over 2 years for 137 patients undergoing laminectomy alone undergoing 2-3 level (58 patients) and 4-6 level (79 patients) Procedures for lumbar stenosis with/without DS. Results showed no new postoperative neurological deficits, no infections, no surgery for adjacent segment disease (ASD), 4 patients (2.9%) who developed intraoperative cerebrospinal fluid (CSF) fistulas, no readmissions, and just 1 reopereation for a (postoperative day 7). These rates were compared to other literature for lumbar laminectomies vs. fusions (e.g. particularly MI TLIF) addressing pathology comparable to that listed above.

RESULTS

Some studies in the literature revealed an average 4.8% complication rate for laminectomy alone vs. 8.3% for decompressions/fusion; at 5 postoperative years, reoperation rates were 10.6% vs. 18.4%, respectively. Specifically, the MI TLIF literature complication rates ranged from 7.7% to 23.0% and included up to an 8.3% incidence of wound infections, 6.1% durotomies, 9.7% permanent neurological deficits, and 20.2% incidence of new sensory deficits. Reoperation rates (1.6-6%) for MI TLIF addressed instrumentation failure (2.3%), cage migration (1.26-2.4%), cage extrusions (0.8%), and misplaced screws (1.6%). The learning curve (e.g. number of cases required by a surgeon to become proficient) for MI TLIF was the first 33-44 cases. Furthermore, hospital costs for lumbar fusions were 2.6 fold greater than those for laminectomy alone, with overall neurosurgeon reimbursement quoted in one study as high as $142,075 per year.

CONCLUSIONS

The spinal literature revealed lower complication and reoperation rates for lumbar laminectomy alone vs. higher rates for instrumented fusion, including MI TLIF, for degenerative lumbar disease with/without DS.

摘要

背景

利用脊柱相关文献，我们比较了单纯椎板切除术与包括微创（MI）经椎间孔腰椎椎体间融合术（TLIF）在内的器械辅助融合术的并发症和再次手术率，这些手术用于治疗伴有或不伴有退变性椎体滑脱（DS）的多节段退变性腰椎疾病。

方法

爱泼斯坦比较了137例接受单纯椎板切除术患者在2年期间的并发症和再次手术率，这些患者分别接受了2 - 3节段（58例）和4 - 6节段（79例）的腰椎管狭窄伴或不伴DS手术。结果显示无新的术后神经功能缺损、无感染、无相邻节段疾病（ASD）手术、4例（2.9%）发生术中脑脊液（CSF）漏、无再次入院，仅1例（术后第7天）再次手术。这些比率与其他关于腰椎椎板切除术与融合术（例如特别是MI TLIF）的文献进行了比较，这些文献所涉及的病理情况与上述情况相当。

结果

文献中的一些研究显示，单纯椎板切除术的平均并发症发生率为4.8%，而减压/融合术为8.3%；术后5年时，再次手术率分别为10.6%和18.4%。具体而言，MI TLIF文献中的并发症发生率在7.7%至23.0%之间，包括高达8.3%的伤口感染发生率、6.1%的硬脊膜切开、9.7%的永久性神经功能缺损以及20.2%的新感觉缺损发生率。MI TLIF的再次手术率（1.6 - 6%）涉及器械故障（2.3%）、椎间融合器移位（1.26 - 2.4%）、椎间融合器脱出（0.8%）和螺钉位置不当（1.6%）。MI TLIF的学习曲线（例如外科医生达到熟练所需的病例数）是最初的33 - 44例。此外，腰椎融合术的住院费用比单纯椎板切除术高2.6倍，一项研究中神经外科医生的总体报销费用高达每年142,075美元。