Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
World Neurosurg. 2019 Aug;128:e744-e751. doi: 10.1016/j.wneu.2019.04.249. Epub 2019 May 8.
Minimally invasive transforaminal lumbar interbody debridement and fusion (MiTLIDF) with percutaneous pedicle screw instrumentation (PSI) is a less invasive treatment for lumbar spondylodiscitis.
Patients with single-level lumbar spondylodiscitis were surgically treated by interbody debridement and fusion through an anterior or transforaminal approach combined with open or percutaneous PSI (group A: anterior debridement and interbody fusion with open posterior PSI; group B: transforaminal lumbar interbody debridement and fusion [TLIDF] with open posterior PSI; group C: anterior debridement and interbody fusion with percutaneous PSI; group D: MiTLIDF with percutaneous PSI). Perioperative data, fusion status, infection-free survival, and clinical outcome measurements were compared among the 4 surgical groups.
A total of 82 patients were included in this study. TLIDF was associated with shorter operative time when compared with the anterior approach (group A: 302.8 ± 59.9 minutes; group B: 209.2 ± 31.0 minutes; group C: 260.6 ± 62.5 minutes; group D: 207.1 ± 33.6 minutes; P < 0.001). Percutaneous PSI resulted in less intraoperative blood loss (group A: 907.5 ± 253.7 mL; group B: 859.4 ± 201.2 mL; group C: 532.9 ± 193.7 mL; group D: 399.1 ± 84.3 mL) and reduced immediate postoperative pain (group A: 5.5 ± 0.9; group B: 4.9 ± 0.9; group C: 3.9 ± 0.7; group D: 3.2 ± 0.7) than open PSI (P < 0.001). There were no significant differences in terms of overall infection-free survival (P = 0.936).
This study demonstrated MiTLIDF with percutaneous PSI is a safe and effective treatment for lumbar spondylodiscitis while incurring no adverse effects in terms of fusion rate, functional recovery, and infection eradication.
微创经椎间孔腰椎体间清创融合术（MiTLIDF）联合经皮椎弓根螺钉内固定术（PSI）是一种治疗腰椎脊椎炎的微创方法。
对单节段腰椎脊椎炎患者进行手术治疗，采用前路或经椎间孔入路联合开放或经皮 PSI 进行椎间清创融合术（A 组：前路清创融合联合开放后路 PSI；B 组：经椎间孔腰椎体间清创融合术联合开放后路 PSI；C 组：前路清创融合联合经皮 PSI；D 组：微创经椎间孔腰椎体间清创融合术联合经皮 PSI）。比较 4 组手术的围手术期数据、融合状态、无感染生存和临床结果测量。
本研究共纳入 82 例患者。与前路入路相比，TLIDF 手术时间更短（A 组：302.8 ± 59.9 分钟；B 组：209.2 ± 31.0 分钟；C 组：260.6 ± 62.5 分钟；D 组：207.1 ± 33.6 分钟；P<0.001）。经皮 PSI 可减少术中出血量（A 组：907.5 ± 253.7 mL；B 组：859.4 ± 201.2 mL；C 组：532.9 ± 193.7 mL；D 组：399.1 ± 84.3 mL）和即刻术后疼痛（A 组：5.5 ± 0.9；B 组：4.9 ± 0.9；C 组：3.9 ± 0.7；D 组：3.2 ± 0.7）较开放 PSI 低（P<0.001）。在无感染生存方面无显著差异（P=0.936）。
本研究表明，微创经椎间孔腰椎体间清创融合术联合经皮 PSI 治疗腰椎脊椎炎是一种安全有效的方法，在融合率、功能恢复和感染清除方面不会产生不良影响。
