Department of Neurosurgery and Orthopedics, Endoscopic Spine Surgery Center, Seoul Bumin Hospital, Seoul, South Korea.
Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, South Korea.
World Neurosurg. 2021 Jan;145:396-404. doi: 10.1016/j.wneu.2020.10.033. Epub 2020 Oct 13.
Although endoscopic transforaminal lumbar interbody fusion (TLIF) may combine the advantages of minimally invasive fusion and endoscopic spine surgery, little evidence exists on endoscopic TLIF. This meta-analysis investigated the clinical results of endoscopic TLIF.
We performed a systematic search of Web-based electronic databases to identify articles on endoscopic lumbar interbody fusion. Only studies of water-based endoscopic TLIF with pedicle screw fixation were included. We analyzed preoperative and postoperative scores for the Oswestry Disability Index (ODI) and visual analog scales (VASs) for back and leg pain to evaluate clinical efficacy. The minimal clinically important difference (MCID) of VAS and ODI was analyzed. We calculated differences in means and 95% confidence intervals and investigated indications for endoscopic TLIF, surgical approaches for endoscopic TLIF, the endoscopic systems that were used, and procedure-related complications.
Thirteen articles were included in this meta-analysis. Uniportal and biportal endoscopic systems were used. Six articles used the posterolateral approach and 7 used the trans-Kambin approach. Preoperative ODI and VAS scores for leg and back pain significantly improved after endoscopic TLIF with percutaneous pedicle screw fixation (P = 0.00). The ODI significantly improved by twice as much as the MCID. The mean change in the VAS for back and leg pain showed significant improvements over the MCID. The perioperative complications were usually minor.
The early clinical results of endoscopic TLIF with percutaneous pedicle screw fixation are favorable. However, long-term outcomes should be investigated and randomized controlled trials should be conducted.
虽然经皮内镜下椎间融合术（TLIF）可能结合了微创融合和内镜脊柱手术的优点，但经皮内镜下 TLIF 的相关证据较少。本荟萃分析旨在研究经皮内镜下 TLIF 的临床效果。
我们对基于网络的电子数据库进行了系统检索，以查找经皮内镜下腰椎融合术的相关文献。仅纳入经皮内镜下 TLIF 且使用椎弓根螺钉固定的研究。我们分析了术前和术后 Oswestry 功能障碍指数（ODI）和腰背腿痛视觉模拟评分（VAS），以评估临床疗效。同时分析了 VAS 和 ODI 的最小临床重要差异（MCID）。我们计算了均值和 95%置信区间的差异，并探讨了经皮内镜下 TLIF 的适应证、TLIF 的手术入路、使用的内镜系统以及与手术相关的并发症。
本荟萃分析纳入了 13 篇文章。使用了单通道和双通道内镜系统。其中 6 篇文章采用后外侧入路，7 篇文章采用经 Kambin 入路。经皮椎弓根螺钉固定的经皮内镜下 TLIF 术后，ODI 和腿痛、腰痛 VAS 评分均显著改善（P<0.001）。ODI 改善程度是 MCID 的两倍，腰痛和腿痛的 VAS 均值变化显著超过 MCID。围手术期并发症通常较轻。
经皮内镜下 TLIF 联合经皮椎弓根螺钉固定的早期临床效果良好。但仍需进一步研究长期疗效，并开展随机对照试验。
