Department of Orthopaedic Surgery, Bumin Hospital Haeundae, Busan, Republic of Korea.
Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
World Neurosurg. 2019 Sep;129:e286-e293. doi: 10.1016/j.wneu.2019.05.130. Epub 2019 May 23.
To compare outcomes of instrumented interbody fusion by the anterior approach (anterior lumbar interbody fusion [ALIF] with posterior pedicle screw fixation [PPF] or lateral lumbar interbody fusion [XLIF] with PPF) or the posterior approach (transforaminal lumbar interbody fusion [TLIF] or posterior lumbar interbody fusion [PLIF]) for spondylolisthesis through meta-analysis.
The MEDLINE via PubMed, Cochrane, Scopus, and Embase databases were searched for studies published between January 2010 and January 2019 evaluating outcomes including lumbar lordosis (LL), segmental lordosis (SL), slip rate, disc height (DH), back visual analogue scale (VAS), leg VAS, and Oswestry disability index (ODI) of ALIF with PPF or XLIF with PPF and TLIF or PLIF for spondylolisthesis. Two authors performed the data extraction independently. Any discrepancies were resolved by a consensus.
Eight comparative studies were identified. There was no significant difference between the anterior approach and the posterior approach for preoperative LL, SL, and DH. In addition, postoperative back and leg VAS, and ODI between the 2 groups were not different. However, the anterior approach was more effective for restoration of postoperative LL, SL, and DH than the posterior approach.
A literature review identified 8 comparative studies reporting outcomes of the anterior approach and the posterior approach in instrumented interbody fusion for spondylolisthesis. Despite heterogeneity, a limited meta-analysis showed that the postoperative restoration of LL, SL, and DH was better in the anterior approach group. Further large multicenter studies would be necessary to substantiate our results.
通过荟萃分析比较前路（前路腰椎间融合术[ALIF]联合后路椎弓根螺钉固定[PPF]或侧路腰椎间融合术[XLIF]联合 PPF）与后路（经椎间孔腰椎间融合术[TLIF]或后路腰椎间融合术[PLIF]）治疗腰椎滑脱的手术效果。
通过 MEDLINE 下的 PubMed、Cochrane、Scopus 和 Embase 数据库检索 2010 年 1 月至 2019 年 1 月发表的评估结果的研究，包括腰椎前凸角（LL）、节段前凸角（SL）、滑脱率、椎间盘高度（DH）、腰背视觉模拟评分（VAS）、下肢 VAS 和 Oswestry 残疾指数（ODI），评估前路（ALIF 联合 PPF 或 XLIF 联合 PPF）与后路（TLIF 或 PLIF）治疗腰椎滑脱的疗效。由两位作者独立进行数据提取。如有分歧，则通过共识解决。
共纳入 8 项比较研究。前路与后路在术前 LL、SL 和 DH 方面无显著差异。此外，两组间术后腰背和下肢 VAS 以及 ODI 也无差异。然而，前路在术后 LL、SL 和 DH 的恢复方面比后路更有效。
文献回顾共纳入 8 项比较前路与后路治疗腰椎滑脱的内固定椎间融合术的研究。尽管存在异质性，但有限的荟萃分析表明，前路组术后 LL、SL 和 DH 的恢复更好。需要进一步进行大型多中心研究来证实我们的结果。
