Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
World Neurosurg. 2019 Jul;127:596-606.e1. doi: 10.1016/j.wneu.2019.03.284. Epub 2019 Apr 5.
Minimally invasive transforaminal interbody fusion (MIS-TLIF) has been shown to have excellent outcomes for surgical management of degenerative disc disease. However, the challenge is in addressing coronal imbalance and restoring lumbar lordosis and sagittal alignment. Use of expandable cages in MIS-TLIF has been hypothesized to circumvent this disadvantage. An indirect meta-analysis of the evidence is presented comparing outcomes from expandable cages with those from nonexpandable cages, in patients undergoing MIS-TLIF.
PRISMA guidelines were used to conduct a systematic review and meta-analysis to compare the clinical and radiologic outcomes of expandable cages and nonexpandable cages in patients undergoing MIS-TLIF.
Twelve studies (706 patients) were included in the meta-analysis. The mean increase in disc height was found to be significantly greater for the nonexpandable cages group than for the expandable cages group (1.33 mm; 95% confidence interval [CI], 1.28-1.38 vs. 1.14 mm,; 95% CI, 1.06-1.23; P < 0.001). No significant difference was found regarding change in lumbar lordosis at last follow-up between the 2 groups (P = 0.34). The mean change in segmental lordosis was found to be significantly higher for the expandable cage group (5.04°, 95% CI, 3.89-6.20 vs. 2.08°, 95% CI, 1.93-2.22; P < 0.001). We did not detect any significant difference in fusion rate (P = 0.33), subsidence rate (P = 0.41) or in reoperations (P = 0.56) at last follow-up between the 2 groups.
Our results indicate that there may not be a significant difference in clinical and radiologic parameters between expandable cages and nonexpandable cages among patients undergoing MIS-TLIF, and it is unclear if the higher cost of the expandable cages is justified.
微创经椎间孔腰椎间融合术（MIS-TLIF）已被证明在退行性椎间盘疾病的手术治疗中具有出色的效果。然而，挑战在于解决冠状面失衡并恢复腰椎前凸和矢状面排列。使用可扩张椎间融合器在 MIS-TLIF 中的应用假设可以规避这一劣势。本文对可扩张椎间融合器与不可扩张椎间融合器在接受 MIS-TLIF 的患者中的疗效进行了间接荟萃分析。
使用 PRISMA 指南进行了一项系统评价和荟萃分析，以比较接受 MIS-TLIF 的患者中可扩张椎间融合器和不可扩张椎间融合器的临床和影像学结果。
荟萃分析纳入了 12 项研究（706 例患者）。结果发现，不可扩张椎间融合器组的椎间盘高度增加明显大于可扩张椎间融合器组（1.33mm；95%置信区间 [CI]，1.28-1.38 比 1.14mm；95%CI，1.06-1.23；P<0.001）。两组患者末次随访时腰椎前凸的变化无显著差异（P=0.34）。可扩张椎间融合器组的节段前凸变化平均值明显较高（5.04°；95%CI，3.89-6.20 比 2.08°；95%CI，1.93-2.22；P<0.001）。我们未发现两组患者在融合率（P=0.33）、下沉率（P=0.41）或末次随访时再手术率（P=0.56）方面有显著差异。
我们的研究结果表明，在接受 MIS-TLIF 的患者中，可扩张椎间融合器与不可扩张椎间融合器之间在临床和影像学参数方面可能没有显著差异，而且目前尚不清楚使用可扩张椎间融合器的更高成本是否合理。
