Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
Clin Neurol Neurosurg. 2020 Sep;196:106003. doi: 10.1016/j.clineuro.2020.106003. Epub 2020 Jun 9.
Enhanced recovery after surgery (ERAS) principle and minimally invasive surgery allow patients to recover faster and better postoperatively. Due to a paucity of their integration, this retrospective study aims to assess clinical outcomes of ERAS pathway in microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
A total of 72 consecutive cases were enrolled. According to their inclusion order, the former 21 cases received microendoscopy-assisted MIS-TLIF without any ERAS approach (control group), while the latter 51 participants underwent the same surgery with ERAS protocol (observation group). Perioperative parameters, including operative duration, intraoperative estimated blood loss (EBL), length of stay, postoperative analgesic usage and ambulatory time, were recorded. Visual analogue scale (VAS, back and leg), Barthel index were obtained before and at three days, one month, six months postoperatively. Modified MacNab criteria and Bridwell grading were used to assess surgical outcome and interbody fusion at one week and two years after surgery, respectively.
Observation group had statistically improved perioperative parameters (operative duration, intraoperative EBL, length of stay, postoperative analgesic usage and ambulatory time) in comparison with control group. Remarkable decreases in VAS (back and leg) were observed continuously at three days, one month and six months post-surgery in both groups when compared with scores prior to the surgery. More significant improvement of VAS (back and leg) was found in observation group at both three days and one month postoperatively. Regarding Barthel index, despite its transient decrease at three days after surgery in control group, it showed statistical increase at postoperative one month when compared with preoperative values in both groups; moreover, its inter-groups comparison revealed much more improvement in patients receiving ERAS recommendations; while at final follow-up, it continued further increase in either group. Marginally higher proportion of patients in observation group showed perfect or good clinical outcome, as well as solid interbody fusion.
ERAS pathway in microendoscopy-assisted MIS-TLIF has advantages of decreased operative time, reduced intraoperative haemorrhage, increased initial back pain relief, decreased length of stay, lowered analgesic usage and earlier daily activity recovery and thus, benefit postoperative rehabilitation further.
手术快速康复（ERAS）原则和微创手术使患者术后更快、更好地恢复。由于缺乏整合，本回顾性研究旨在评估 ERAS 途径在微创经椎间孔腰椎体间融合术（MIS-TLIF）中的临床效果。
共纳入 72 例连续病例。根据纳入顺序，前 21 例患者接受了无任何 ERAS 方法的微创经椎间孔腰椎体间融合术（对照组），而其余 51 例患者接受了相同的手术和 ERAS 方案（观察组）。记录围手术期参数，包括手术时间、术中估计出血量（EBL）、住院时间、术后镇痛使用和活动时间。术前及术后 3 天、1 个月、6 个月时采用视觉模拟评分（VAS，腰背）、巴氏指数进行评估。术后 1 周和 2 年分别采用改良 MacNab 标准和 Bridwell 分级评估手术效果和椎间融合情况。
观察组的围手术期参数（手术时间、术中 EBL、住院时间、术后镇痛使用和活动时间）明显优于对照组。与术前相比，两组患者术后 3 天、1 个月和 6 个月时 VAS（腰背）均持续下降，观察组术后 3 天和 1 个月时 VAS（腰背）改善更为明显。两组患者术后 1 个月的巴氏指数均较术前增加，而对照组术后 3 天的巴氏指数略有下降。观察组接受 ERAS 推荐的患者在术后各时间点的改善更为明显；在最终随访时，两组患者的巴氏指数均继续增加。观察组有更高比例的患者获得了良好或优秀的临床结果，且椎间融合更为牢固。
微创经椎间孔腰椎体间融合术联合 ERAS 方案具有减少手术时间、减少术中出血、更快缓解初始腰背疼痛、缩短住院时间、减少镇痛使用和更早恢复日常活动的优势，从而进一步促进术后康复。
