Qin Rongqing, Liu Baoshan, Zhou Pin, Yao Yu, Hao Jie, Yang Kai, Xu Tian Li, Zhang Feng, Chen Xiaoqing
Medical College of Nantong University, Nantong, Jiangsu, China; Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Medical College of Nantong University, Nantong, Jiangsu, China.
World Neurosurg. 2019 Feb;122:180-189. doi: 10.1016/j.wneu.2018.10.202. Epub 2018 Nov 7.
To compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of single-level spondylolisthesis grades 1 and 2.
This was a systematic review and meta-analysis. A comprehensive literature retrieval was performed in 3 electronic databases (PubMed, Embase, and Cochrane library). Randomized or nonrandomized controlled studies published from January 2000 to April 2018 that compared minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with traditional open transforaminal lumbar interbody fusion (TO-TLIF) for treating single-level spondylolisthesis grades 1 and 2 were retrieved. Quality of included studies were evaluated by the modified Jadad scale. Data were extracted according to the predefined clinical outcome measures, including preoperative and postoperative back pain visual analogue scale and Oswestry Disability Index score; operation time and estimated intraoperative blood loss; length of hospitalization; and the complications, reoperation, and fusion rate.
Six studies (n = 394 patients) were finally included. Two were randomized controlled trials and the remaining 4 were prospective or retrospective cohort studies. The pooled data revealed that both techniques had similar preoperative and last follow-up back pain visual analogue scale scores, complication rate, reoperation rate, and fusion rate. However, with the exception of more operation time, MIS-TLIF was associated with less intraoperative blood loss, shorter hospital stay, and better long-term functional outcome when compared with TO-TLIF.
Based on the available evidence, MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue trauma, quicker postoperative recovery, and better long-term functional outcome for the treatment of single-level spondylolisthesis grades 1 and 2.
比较微创与传统开放经椎间孔腰椎椎间融合术治疗1级和2级单节段腰椎滑脱的临床疗效和安全性。
这是一项系统评价和荟萃分析。在3个电子数据库（PubMed、Embase和Cochrane图书馆）中进行了全面的文献检索。检索2000年1月至2018年4月发表的比较微创经椎间孔腰椎椎间融合术（MIS-TLIF）与传统开放经椎间孔腰椎椎间融合术（TO-TLIF）治疗1级和2级单节段腰椎滑脱的随机或非随机对照研究。采用改良Jadad量表评估纳入研究的质量。根据预先定义的临床结局指标提取数据，包括术前和术后背痛视觉模拟量表及Oswestry功能障碍指数评分；手术时间和估计术中失血量；住院时间；以及并发症、再次手术和融合率。
最终纳入6项研究（n = 394例患者）。2项为随机对照试验，其余4项为前瞻性或回顾性队列研究。汇总数据显示，两种技术在术前和末次随访时的背痛视觉模拟量表评分、并发症发生率、再次手术率和融合率方面相似。然而，与TO-TLIF相比，除了手术时间更长外，MIS-TLIF术中失血量更少、住院时间更短且长期功能结局更好。
基于现有证据，MIS-TLIF似乎是一种更有效、安全的技术，组织创伤更小，术后恢复更快，治疗1级和2级单节段腰椎滑脱的长期功能结局更好。
