Bozkurt Gokhan, Isikay Ilkay, Hanalioglu Sahin
Department of Neurosurgery, Istinye University, Istanbul, Turkey.
Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey.
World Neurosurg. 2018 Aug;116:e1060-e1065. doi: 10.1016/j.wneu.2018.05.165. Epub 2018 Jun 1.
Fusion surgery for lumbar degenerative stenosis is an established treatment mode. Despite comparable patient-related outcomes and radiologic results, the necessity of adding interbody fusion to posterolateral fusion remains controversial. We aimed to compare the clinical and radiologic outcomes of posterolateral fusion and transforaminal interbody fusion techniques in degenerative lumbar stenosis with or without spondylolisthesis.
We retrospectively evaluated the clinical and radiologic outcomes of 48 patients who underwent decompression plus either posterolateral fusion (PLF; n = 23) or transforaminal interbody fusion (TLIF) plus PLF (TLIF+PLF; n = 25) procedures, which incorporated 71 segments for degenerative lumbar stenosis with or without spondylolisthesis.
The median follow-up duration for the PLF and TLIF groups were 26 and 31 months, respectively. Both procedures significantly improved the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores; however, the postoperative ODI and VAS scores were unaffected by the procedure type. Postoperative disc heights and percent changes in disc heights did not change by operation type; however, the percent change in the foramen areas was significantly greater in the TLIF group. The addition of TLIF to the PLF procedure resulted in significantly longer operating time and more intraoperative blood loss. Cerebrospinal fluid fistula was the only major complication noted. The radiologic fusion rates were similar between both study groups.
Both PLF and TLIF+PLF procedures were effective in ameliorating the symptoms of degenerative lumbar stenosis and spondylolisthesis. Although some radiologic parameters favor TLIF, this was not reflected in the clinical outcomes.
腰椎退变性狭窄的融合手术是一种既定的治疗方式。尽管患者相关结局和影像学结果相当，但在后外侧融合基础上加用椎间融合的必要性仍存在争议。我们旨在比较单纯后外侧融合与经椎间孔椎间融合技术在伴或不伴椎体滑脱的退变性腰椎狭窄中的临床和影像学结局。
我们回顾性评估了48例行减压术加单纯后外侧融合（PLF；n = 23）或经椎间孔椎间融合（TLIF）加PLF（TLIF + PLF；n = 25）手术患者的临床和影像学结局，这些手术涉及71个伴或不伴椎体滑脱的退变性腰椎狭窄节段。
PLF组和TLIF组的中位随访时间分别为26个月和31个月。两种手术均显著改善了Oswestry功能障碍指数（ODI）和视觉模拟评分（VAS）；然而，术后ODI和VAS评分不受手术类型的影响。术后椎间盘高度及椎间盘高度的百分比变化不受手术类型影响；然而，TLIF组椎间孔面积的百分比变化显著更大。PLF手术加用TLIF导致手术时间显著延长和术中出血量增加。脑脊液漏是唯一记录到的主要并发症。两个研究组的影像学融合率相似。
PLF和TLIF + PLF手术在改善退变性腰椎狭窄和椎体滑脱症状方面均有效。尽管一些影像学参数有利于TLIF，但这并未反映在临床结局中。
