Chen Kangwu, Chen Hao, Zhang Kai, Yang Peng, Sun Jiajia, Mo Jianqiang, Zhou Feng, Yang Huilin, Mao Haiqing
Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Clin Spine Surg. 2019 Jun;32(5):E235-E240. doi: 10.1097/BSD.0000000000000804.
This is a retrospective study.
The purpose of this study is to compare the clinical outcomes between O-arm navigation combined with microscope-assisted minimally invasive transforaminal lumbar interbody fusion (novel MIS-TLIF) and open-TLIF for the treatment of 1-level lumbar degenerative disease.
MIS-TLIF is becoming increasingly popular; however, the limited visualization may increase various surgical complications. O-arm navigation and microscope have the potential to display the specific anatomic structures and better magnification.
This study involved 45 patients with 1-level lumbar degenerative disease who underwent novel MIS-TLIF or open-TLIF. Operating time, intraoperative blood loss, and hospitalization stay were analyzed. The accuracy of pedicle screw placement was assessed by computed tomography. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) were assessed preoperatively and postoperatively.
Intraoperative blood loss was significantly less in the novel MIS-TLIF group compared with the open-TLIF group (P<0.05). The average time for hospitalization stay in the novel MIS-TLIF group was significantly shorter than open-TLIF group (P<0.05). However, the operative time of novel MIS-TLIF group was longer than open-TLIF group (P<0.05). The accuracy rate of pedicle screw position in the novel MIS-TLIF group which guided by O-arm navigation was higher than conventional open-TLIF group (96.4% vs. 86.5%; P<0.05). Meanwhile, the VAS score for the low back pain and ODI score in the novel MIS-TLIF group were lower than that in the open-TLIF group 1 month after surgery (P<0.05). No difference of the VAS score for leg pain was found between these 2 groups (P>0.05), neither as the fusion rate in between the 2 groups (P>0.05).
O-arm navigation combined with microscope-assisted MIS-TLIF may has several advantages including less blood loss, shorter hospitalization stay, higher accuracy of pedicle screw placement, and faster recovery period in treating 1-level lumbar degenerative disease.
这是一项回顾性研究。
本研究旨在比较O型臂导航联合显微镜辅助微创经椎间孔腰椎椎间融合术（新型微创经椎间孔腰椎椎间融合术）与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退行性疾病的临床疗效。
微创经椎间孔腰椎椎间融合术越来越受欢迎；然而，可视化受限可能会增加各种手术并发症。O型臂导航和显微镜有显示特定解剖结构和更好放大倍数的潜力。
本研究纳入了45例接受新型微创经椎间孔腰椎椎间融合术或开放经椎间孔腰椎椎间融合术的单节段腰椎退行性疾病患者。分析手术时间、术中出血量和住院时间。通过计算机断层扫描评估椎弓根螺钉置入的准确性。术前和术后评估视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。
新型微创经椎间孔腰椎椎间融合术组术中出血量明显少于开放经椎间孔腰椎椎间融合术组（P<0.05）。新型微创经椎间孔腰椎椎间融合术组的平均住院时间明显短于开放经椎间孔腰椎椎间融合术组（P<0.05）。然而，新型微创经椎间孔腰椎椎间融合术组的手术时间长于开放经椎间孔腰椎椎间融合术组（P<0.05）。O型臂导航引导下的新型微创经椎间孔腰椎椎间融合术组椎弓根螺钉位置的准确率高于传统开放经椎间孔腰椎椎间融合术组（96.4%对86.5%；P<0.05）。同时，新型微创经椎间孔腰椎椎间融合术组术后1个月的下腰痛VAS评分和ODI评分低于开放经椎间孔腰椎椎间融合术组（P<0.05）。两组之间腿痛的VAS评分没有差异（P>0.05），两组之间的融合率也没有差异（P>0.05）。
O型臂导航联合显微镜辅助微创经椎间孔腰椎椎间融合术在治疗单节段腰椎退行性疾病方面可能具有出血少、住院时间短、椎弓根螺钉置入准确性高和恢复期快等优点。
