Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic.
World Neurosurg. 2021 Oct;154:e641-e648. doi: 10.1016/j.wneu.2021.07.108. Epub 2021 Jul 29.
Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF.
This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant.
The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded.
MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.
中线腰椎融合术（MIDLF）是一种有前途的新手术技术，旨在最大限度地减少围手术期对椎旁稳定肌-腱系统的损伤。本研究旨在评估 MIDLF 的长期临床和影像学效果。
本前瞻性队列研究评估了因退行性脊柱不稳定而行 MIDLF 的患者。手术前后进行临床和影像学检查。记录围手术期和术后并发症。随访时间为 2 年。P≤0.05 为统计学显著差异。
研究纳入 64 例患者（平均年龄 58.9±10.7 岁；41 例女性[64.1%]）。MIDLF 的最常见适应证是 I 度退行性脊椎滑脱（28 例[43.8%]）；最常见的融合脊柱节段为 L4-L5（35 例[54.7%]）。手术平均时间为 148.2±28.9 分钟。视觉模拟评分（VAS）评估显示，术后腰痛和腿痛明显缓解且稳定（P<0.001）。术后 2 年，根据 MacNab 评分，86.9%的患者报告疼痛缓解为良好、优或极好。Oswestry 功能障碍指数（ODI）评分显示，患者日常生活活动能力显著改善：从术前的 66.8±9.8 分提高到术后 2 年的 33.9±16.5 分（P<0.001）。术后 12 个月 X 线和 CT 显示 46 例（73.4%）椎间融合，13 例（20.3%）结果不确定，4 例（6.3%）无融合。未记录到神经或血管结构损伤，也未出现内固定物失效或螺钉松动。
MIDLF 是治疗腰椎不稳定的一种安全、有效的手术方法。其微创性有助于更好地保留椎旁肌肉，增强术后脊柱稳定性。
