后路腰椎间融合或间接减压后行侧路腰椎间融合治疗患者报告的生活质量。
Patient-reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion.
机构信息
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan.
Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
出版信息
Spine (Phila Pa 1976). 2020 Sep 15;45(18):E1172-E1178. doi: 10.1097/BRS.0000000000003535.
STUDY DESIGN
A retrospective review of prospectively collected data.
OBJECTIVE
The aim of this study was to compare quality of life (QOL) outcomes of posterior lumbar interbody fusion (PLIF) with lateral lumbar interbody fusion (LLIF) using reports from patients obtained at the 2-year postoperative follow-up.
SUMMARY OF BACKGROUND DATA
Indirect decompression with LLIF is used to treat degenerative lumbar diseases that require neural decompression. However, the difference in improvement in QOL following indirect decompression compared with direct neural decompression using PLIF is unclear.
METHODS
We enrolled 284 consecutive patients with degenerative lumbar spondylolisthesis in the present study, 203 who underwent PLIF and 81 who underwent LLIF. All patients completed a minimum of 2 years of follow-up. We evaluated the effectiveness of surgery in each category of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).
RESULTS
The results of preoperative JOABPEQ and the severity of thecal sac stenosis were not significantly different between PLIF and LLIF, neither was the rate of perioperative complications (14.8% and 15.4% for the PLIF and LLIF groups, respectively; P = 0.91). The effectiveness at 2 years postoperatively was almost the same for all five domains of the JOABPEQ: 62.6% and 68.9% for pain-related disorders (P = 0.34), 38.3% and 42.7% for lumbar spine dysfunction (P = 0.51), 65.8% and 67.5% for gait disturbance (P = 0.79), 53.5% and 48.8% for social life dysfunction (P = 0.47), and 29.1% and 33.3% for psychological disorders (P = 0.48) following PLIF and LLIF, respectively. Visual analogue scale results for back and lower-limb pain and numbness of the lower limbs were almost the same for both groups. No significant differences were observed in terms of perioperative complications and radiographical outcomes.
CONCLUSION
Indirect decompression using LLIF improves QOL and radiographical outcomes to a comparable degree as direct decompression via PLIF.
LEVEL OF EVIDENCE
研究设计
前瞻性数据回顾性研究。
目的
本研究旨在比较后路腰椎体间融合术（PLIF）与侧路腰椎体间融合术（LLIF）治疗退行性腰椎疾病患者 2 年术后随访时的生活质量（QOL）结局。
背景资料概要
LLIF 用于治疗需要神经减压的退行性腰椎疾病，可进行间接减压。但是，与使用 PLIF 进行直接神经减压相比，间接减压后 QOL 改善的差异尚不清楚。
方法
我们纳入了 284 例退行性腰椎滑脱患者，其中 203 例行 PLIF，81 例行 LLIF。所有患者均完成了至少 2 年的随访。我们评估了日本骨科协会腰痛评估问卷（JOABPEQ）每个类别的手术效果。
结果
PLIF 和 LLIF 组术前 JOABPEQ 和硬脊膜囊狭窄程度无显著差异，围手术期并发症发生率也无差异（PLIF 组和 LLIF 组分别为 14.8%和 15.4%；P=0.91）。2 年时 JOABPEQ 的所有五个领域的疗效几乎相同：疼痛相关障碍为 62.6%和 68.9%（P=0.34），腰椎功能障碍为 38.3%和 42.7%（P=0.51），步态障碍为 65.8%和 67.5%（P=0.79），社会生活障碍为 53.5%和 48.8%（P=0.47），心理障碍为 29.1%和 33.3%（P=0.48）。两组患者的腰背疼痛和下肢麻木的视觉模拟评分结果几乎相同。两组在围手术期并发症和影像学结果方面无显著差异。
结论
LLIF 间接减压在改善 QOL 和影像学结果方面与 PLIF 直接减压的效果相当。
证据等级
4 级。
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