Byvaltsev V A, Kalinin A A, Goloborodko V Yu, Shepelev V V, Pestryakov Yu Ya, Konovalov N A
Irkutsk State Medical University, Irkutsk, Russia.
Private Healthcare Institution «Clinical Hospital» Russian Railways-Medicine, Irkutsk, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2021;85(1):36-46. doi: 10.17116/neiro20218501136.
Minimally invasive procedures reduce the trauma of spine surgery. However, they are associated with high complexity of manipulations, long learning curve, need for expensive equipment for intraoperative navigation and significant irradiation. Various options for surgical approaches are being developed to reduce irradiation of medical staff and patients, surgery time and the number of drugs administered for general anesthesia. Simultaneous surgical interventions (SiSI) is one of these options.
To compare the effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases.
A prospective study included 67 patients (41 men and 26 women) aged 48 (34; 56) years who underwent a single-level minimally invasive spinal root decompression and transforaminal interbody fusion via Wiltse posterior-lateral approach. Two study groups were distinguished: group I (simultaneous surgical interventions, SiSI) (=29), in which guide spokes and transpedicular screws were installed simultaneously by two surgeons within one x-ray session from two sides; group II (staged surgical interventions, StSI) (=38), in which staged transpedicular stabilization was performed (decompression side followed by contralateral side). Mean follow-up was 14 months in group I and 20 months in group II. We considered intraoperative fluoroscopy and irradiation dose, duration of surgery and anesthesia with calculation of doses of opioid drugs, blood loss, time of activation, hospital-stay and perioperative morbidity. Clinical outcomes were studied in long-term postoperative period.
Simultaneous approach ensured less time of intraoperative fluoroscopy (=0.029) and irradiation dose (=0.035), duration of surgery (=0.01) and anesthesia (=0.02), amount of opioid drugs during anesthesia (=0.017). Blood loss, duration of activation and hospitals-stay were similar in both groups (=0.35, =0.12 and =0.57, respectively). There was comparable improvement in VAS score of pain in the lumbar spine and lower extremities in both groups (=0.63 and =0.31, respectively). According to SF-36 questionnaire, there was no between-group difference in physical and psychological components (=0.44 and =0.72, respectively). There was significantly greater number of adverse effects of anesthesia in the StSI group (26.2% vs. 6.8%, =0.003). At the same time, the number of surgical postoperative complications was similar in both groups (3.4% vs. 5.3%, =0.62).
Simultaneous minimally invasive dorsal decompression-stabilization procedures have some significant advantages over staged approach regarding intraoperative parameters and adverse effects of anesthesia in patients with lumbar spine degenerative diseases. Nevertheless, there were similar clinical data and small incidence of surgical perioperative complications.
微创手术可减少脊柱手术的创伤。然而，它们与操作的高度复杂性、较长的学习曲线、术中导航所需的昂贵设备以及大量辐射相关。正在开发各种手术入路选项，以减少医护人员和患者的辐射、手术时间以及全身麻醉用药数量。同时进行的手术干预（SiSI）就是其中一种选项。
比较同时进行和分期进行的微创后路减压 - 稳定手术治疗腰椎退行性疾病患者的有效性。
一项前瞻性研究纳入了67例患者（41例男性和26例女性），年龄48（34；56）岁，均通过Wiltse后外侧入路接受单节段微创脊髓神经根减压和经椎间孔椎间融合术。区分出两个研究组：第一组（同时进行的手术干预，SiSI）（=29例），由两名外科医生在一次X线检查期间从两侧同时安装导向杆和椎弓根螺钉；第二组（分期进行的手术干预，StSI）（=38例），进行分期椎弓根稳定术（先减压侧，后对侧）。第一组的平均随访时间为14个月，第二组为20个月。我们考虑了术中透视和辐射剂量、手术和麻醉持续时间，并计算了阿片类药物剂量、失血量、激活时间、住院时间和围手术期发病率。在术后长期观察临床结果。
同时进行的手术入路确保了术中透视时间（=0.029）、辐射剂量（=0.035）、手术持续时间（=0.01）和麻醉持续时间（=0.02）、麻醉期间阿片类药物用量（=0.017）更少。两组的失血量、激活持续时间和住院时间相似（分别为=0.35、=0.12和=0.57）。两组腰椎和下肢疼痛的视觉模拟评分（VAS）均有类似改善（分别为=0.63和=0.31）。根据SF - 36问卷，两组在身体和心理方面无差异（分别为=0.44和=0.72）。StSI组麻醉不良反应显著更多（26.2%对6.8%，=0.003）。同时，两组手术术后并发症数量相似（3.4%对5.3%，=0.62）。
对于腰椎退行性疾病患者，在术中参数和麻醉不良反应方面，同时进行的微创后路减压 - 稳定手术比分期手术有一些显著优势。然而，临床数据相似，手术围手术期并发症发生率较低。
