Spine Institute Northwest, Bothell, Washington.
Spine Institute Northwest, Bothell, WA.
Pain Physician. 2019 Jan;22(1):75-88.
Open transforaminal lumbar interbody fusion (TLIF) is the gold standard treatment for back pain due to degenerative disc disease and lumbar instability. Traditional open TLIF has been associated with extensive tissue dissection, excessive blood loss, and slow recovery time. Full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) is an evolving treatment.
This study aims to review outcomes of FE-TLIF performed in an ambulatory surgery center (ASC) on patients with advanced disc disease with minimal spinal deformity.
This study employed a retrospective cohort design.
This Western Institutional Review Board-approved study (#1-925640-1) assessed blood loss, operative time (OR time), post anesthesia care unit time (PACU time), and Visual Analog Scale (VAS) of 85 patients who underwent FE-TLIF between 2011 and 2015 and were followed up for 12 months. Relationships between risk factors (demographics, clinical presentation) and outcomes were analyzed.
No intraoperative complications were observed. There were 2 cases of postoperative sympathetically mediated pain and 3 reoperations. The number of decompression/fusion levels was crucial to OR time but had a smaller impact on PACU time. OR time for patients with 2-level fusion was 110 minutes longer than for those with one level operation. BMI and age had no significant effect on OR time. BMI had a modest effect on PACU time. Gender and age did not affect PACU time. A significant decrease in VAS was observed.
This study has several limitations, including the lack of a control group and reliance on patient-reported outcomes (VAS). In addition, fusion rate and global sagittal alignment were not measured. Although not statistically significant, the use of facet screws, unilateral, or bilateral pedicle screws presented variation in techniques within the group. Early recovery also diminished the incentive for long-term follow-up.
FE-TLIF is a feasible technique for lumbar stabilization surgery in an ASC in select patients. This level-II study demonstrates safety in a variety of clinical presentations, including obesity, extremes of age, and anatomical access challenge. Larger clinical series are necessary to validate this technique, particularly for the treatment of patients with advanced spinal deformities.
Full-endoscopic, minimally invasive spine surgery, postoperative complications,TLIF, lumbar fusion, low back pain.
经椎间孔腰椎体间融合术（TLIF）是治疗退行性椎间盘疾病和腰椎不稳引起的腰痛的金标准。传统的开放式 TLIF 与广泛的组织解剖、大量失血和缓慢的恢复时间有关。全内窥镜经椎间孔腰椎体间融合术（FE-TLIF）是一种不断发展的治疗方法。
本研究旨在回顾在脊柱畸形程度最小的门诊手术中心（ASC）进行的 FE-TLIF 治疗进展性椎间盘疾病患者的结果。
本研究采用回顾性队列设计。
这项经西方机构审查委员会批准的研究（#1-925640-1）评估了 85 例患者的出血量、手术时间（OR 时间）、麻醉后护理时间（PACU 时间）和视觉模拟量表（VAS），这些患者在 2011 年至 2015 年间接受了 FE-TLIF 治疗，并随访了 12 个月。分析了危险因素（人口统计学、临床表现）与结果之间的关系。
术中无并发症发生。有 2 例术后交感神经介导性疼痛和 3 例再手术。减压/融合节段数对 OR 时间至关重要，但对 PACU 时间的影响较小。2 级融合患者的 OR 时间比 1 级手术患者长 110 分钟。BMI 和年龄对 OR 时间无显著影响。BMI 对 PACU 时间有一定影响。性别和年龄对 PACU 时间无影响。VAS 显著下降。
本研究存在一些局限性，包括缺乏对照组和依赖于患者报告的结果（VAS）。此外，未测量融合率和整体矢状面排列。尽管没有统计学意义，但在该组中，关节突螺钉的使用、单侧或双侧椎弓根螺钉的使用存在技术上的差异。早期恢复也降低了长期随访的动力。
FE-TLIF 是 ASC 中选择患者进行腰椎稳定手术的可行技术。这项 II 级研究证明了在多种临床表现（包括肥胖、极端年龄和解剖学通道挑战）中安全性。需要更大的临床系列来验证这项技术，特别是治疗进展性脊柱畸形患者。
全内窥镜、微创脊柱外科、术后并发症、TLIF、腰椎融合、下腰痛。
