Tabaraee Ehsan, Ahn Junyoung, Aboushaala Khaled, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Int J Spine Surg. 2020 Oct;14(5):736-744. doi: 10.14444/7106. Epub 2020 Oct 23.
Minimally invasive (MIS) techniques have gained considerable attention for the management of degenerative spinal pathologies. However, few studies have compared the outcomes between MIS and open thoracolumbar corpectomies. The purpose of this study was to compare perioperative variables between MIS and open thoracolumbar corpectomy.
Retrospective review of 33 patients who underwent either an MIS or open thoracolumbar corpectomy by a single surgeon between 2005 and 2012 was performed. Patients were separated into anterior-posterior MIS (MIS AP), anterior-posterior open (AP), and posterior open (P) cohorts. Postoperative narcotic use was converted to oral morphine equivalents (OMEs). Demographics, comorbidity, perioperative variables, complications, and computed tomographic analyses were assessed. Fisher exact test was performed for categorical variables and Student test for continuous variables. A value of ≤ .05 denoted statistical significance.
Thirty-three patients underwent an MIS AP, AP, or P thoracolumbar corpectomy (39.4% vs 15.2% vs 45.5%, respectively). MIS AP patients were younger with a lower comorbidity burden than either open cohorts. In addition, MIS AP patients demonstrated a decreased procedural time, lower blood loss, and shorter hospitalization than either open cohorts. MIS AP patients required less units of transfusion than P and AP patients while demonstrating lower postoperative narcotics consumption and reoperations rates than open AP patients. Surgical site infection rates, body mass index, intraoperative fluid requirements, and complication rates were similar between cohorts. All patients demonstrated successful arthrodesis at 1 year based upon computed tomography.
MIS AP thoracolumbar corpectomy patients incurred decreased procedural times, shorter hospitalization, and lower blood loss compared with open patients. MIS AP patients demonstrated decreased postoperative narcotics consumption and reoperation rates compared with traditional AP patients. All patients demonstrated successful arthrodesis.
The MIS approach to thoracolumbar corpectomies appears to be a safe and efficacious alternative when compared with traditional methods.
微创（MIS）技术在退行性脊柱疾病的治疗中受到了广泛关注。然而，很少有研究比较MIS与开放性胸腰椎椎体次全切除术的疗效。本研究的目的是比较MIS与开放性胸腰椎椎体次全切除术的围手术期变量。
对2005年至2012年间由同一外科医生实施MIS或开放性胸腰椎椎体次全切除术的33例患者进行回顾性研究。患者被分为前后路MIS（MIS AP）、前后路开放（AP）和后路开放（P）三组。术后麻醉药物用量换算为口服吗啡当量（OME）。评估人口统计学、合并症、围手术期变量、并发症和计算机断层扫描分析结果。分类变量采用Fisher精确检验，连续变量采用Student检验。P值≤0.05表示具有统计学意义。
33例患者接受了MIS AP、AP或P胸腰椎椎体次全切除术（分别为39.4%、15.2%和45.5%）。MIS AP组患者比任何一个开放手术组的患者都更年轻，合并症负担更低。此外，MIS AP组患者的手术时间缩短、失血量减少、住院时间比任何一个开放手术组都短。MIS AP组患者所需的输血量比P组和AP组患者少，同时术后麻醉药物消耗量和再次手术率比开放AP组患者低。各队列之间的手术部位感染率、体重指数、术中液体需求量和并发症发生率相似。根据计算机断层扫描，所有患者在1年时均显示融合成功。
与开放手术患者相比，MIS AP胸腰椎椎体次全切除术患者的手术时间缩短、住院时间缩短、失血量减少。与传统AP组患者相比，MIS AP组患者的术后麻醉药物消耗量和再次手术率降低。所有患者均显示融合成功。
与传统方法相比，MIS胸腰椎椎体次全切除术似乎是一种安全有效的替代方法。
