Inoue Tetsuji, Mizutamari Masaya, Hatake Kuniaki
Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan.
Asian Spine J. 2021 Dec;15(6):856-864. doi: 10.31616/asj.2020.0296. Epub 2020 Dec 30.
Single-center retrospective study.
This study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS).
Intraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness.
This study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF).
No significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50-367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260-760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180-890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145-637 mL) than in the PS-PLIF (639.6 mL; range, 285-1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270-950 mL; p=0.005) groups.
Based on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.
单中心回顾性研究。
本研究旨在通过比较单节段后路腰椎椎间融合术（PLIF）与传统椎弓根螺钉（PS）、皮质骨轨迹螺钉（CBT）和经皮椎弓根螺钉（PPS）的围手术期失血量，评估PLIF的手术侵袭性。
术中失血量常被用于评估手术侵袭性。然而，在接受脊柱手术的患者中，术后失血量比术中更多。因此，仅使用术中出血量评估手术侵袭性可能会导致对实际手术侵袭性的严重低估。
本研究纳入了2012年1月至2017年12月期间接受单节段PLIF的患者。共有7例患者接受了PS-PLIF，9例接受了CBT-PLIF，15例接受了PPS-PLIF。
PS-PLIF、CBT-PLIF和PPS-PLIF组在手术时间或术中出血方面未观察到显著差异。然而，PPS-PLIF组的术后引流量（210.1 mL；范围50-367 mL）被确定显著低于PS-PLIF组（416.7 mL；范围260-760 mL；p=0.002）和CBT-PLIF组（421.1 mL；范围180-890 mL；p=0.006）。此外，发现PPS-PLIF组的术中出血总量和术后引流量（362.8 mL；范围145-637 mL）显著低于PS-PLIF组（639.6 mL；范围285-1000 mL；p=0.01）和CBT-PLIF组（606.7 mL；范围270-950 mL；p=0.005）。
基于我们的研究结果，仅使用术中出血评估手术侵袭性可能会低估实际手术侵袭性。即使是单节段PLIF，围手术期出血量也可能因后路器械的安装方式而异。
