G. S.-H. Goh, Y. W. A. Tay, M. H. L. Liow, C. Gatot, Z. M. Ling, P. L. Fong, R. C. C. Soh, C. M. Guo, J. L.-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
W. M. Yue, The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore.
Clin Orthop Relat Res. 2020 Apr;478(4):822-832. doi: 10.1097/CORR.0000000000001054.
Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.
QUESTIONS/PURPOSES: We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.
Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.
There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).
When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.
Level II, prognostic study.
尽管有几项研究表明，微创经椎间孔腰椎体间融合术（MIS-TLIF）可能对老年患者特别有益，因为它的手术发病率较低，术后恢复较快，但关于老年患者接受 MIS-TLIF 后的功能结果、生活质量和满意度的研究有限。此外，现有的研究存在显著的临床、诊断和手术异质性。
问题/目的：我们想知道，老年患者在接受 MIS-TLIF 后是否能够获得可比的（1）患者报告的疼痛、残疾和生活质量，（2）围手术期并发症，以及（3）放射学融合率，就像他们年轻的患者一样。
我们回顾了 2012 年至 2014 年间接受原发性、单节段、MIS-TLIF 治疗退行性滑脱症的患者的前瞻性收集的登记数据。我们纳入了 168 名患者，其中 39 名患者年龄至少 70 岁。在 129 名年龄小于 70 岁的患者中，使用倾向评分匹配选择了 39 名年龄较小的对照组，调整了性别、BMI、美国麻醉医师协会评分和基线临床结果。比较了围手术期并发症和影像学数据。
术后 2 年内，背部疼痛（平均差值-0.3[95%置信区间-1.0 至 0.5]；p=0.52）；腿部疼痛（平均差值-0.1[95%置信区间-0.6 至 0.5]；p=0.85）；Oswestry 残疾指数（平均差值-2.9[95%置信区间-8.0 至 2.2]；p=0.26）；和 SF-36 身体（平均差值 3.0[95%置信区间-0.7 至 6.8]；p=0.107）；和精神成分综合（平均差值 1.9[95%置信区间-4.5 至 8.2]；p=0.56）；在术后 2 年内没有差异；年轻患者中 85%和老年患者中 85%的患者表示满意（p＞0.99），而分别有 87%和 80%的患者满足了预期（p=0.36）。每组都有 4 例围手术期不良事件。融合率也没有差异（年轻患者为 87%，老年患者为 90%；p=0.135）。
当临床和手术异质性最小化时，接受微创经椎间孔腰椎体间融合术的老年患者不仅具有可比的围手术期并发症发生率，而且在疼痛、功能和生活质量方面也有相似的改善。满意度很高。
二级，预后研究。
