Zabat Michelle A, Mottole Nicole A, Ashayeri Kimberly, Norris Zoe A, Patel Hershil, Sissman Ethan, Balouch Eaman, Maglaras Constance, Protopsaltis Themistocles S, Buckland Aaron J, Fischer Charla R
Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Global Spine J. 2023 Oct;13(8):2508-2515. doi: 10.1177/21925682221089244. Epub 2022 Apr 5.
Single-center retrospective cohort study.
To evaluate inpatient MME administration associated with different lumbar spinal fusion surgeries.
Patients ≥18 years of age with a diagnosis of Grade I or II spondylolisthesis, stenosis, degenerative disc disease or pars defect who underwent one-level Transforaminal Lumbar Interbody Fusion (TLIF) or one-level Anterior Lumbar Interbody Fusion (ALIF) or Lateral Lumbar Interbody Fusion (LLIF) through traditional MIS, anterior-posterior position or single position approaches between L2-S1. Outcome measures included patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. Statistical analysis included one-way ANOVA with a post-hoc Tukey Test and Kruskal-Wallis Test with post-hoc Mann-Whitney test. MME was calculated as per the Centers for Medicare and Medicaid Services and previous literature. Significance set at < .05.
Mean age differed significantly between MIS TLIF (55.6 ± 12.5 years) and all other groups (Open TLIF 57.1 ± 12.5, SP ALIF/LLIF 57.9 ± 9.9, TP ALIF/LLIF 50.9 ± 12.7, Open ALIF/LLIF 58.4 ± 15.5). MIS TLIF had the shortest LOS compared to all groups except SP ALIF/LLIF. Total MME was significantly different between MIS TLIF and Open ALIF/LLIF (172.5 MME vs 261.1 MME, = .044) as well as MIS TLIF and TP ALIF/LLIF (172.5 MME vs 245.4 MME, = .009). There were no significant differences in MME/hour and incidence of ileus between all groups.
Patients undergoing MIS TLIF had lower inpatient opioid intake compared to TP and SP ALIF/LLIF, as well as shorter LOS compared to all groups except SP ALIF/LLIF. Thus, it appears that the advantages of minimally invasive surgery are seen in minimally invasive TLIFs.
单中心回顾性队列研究。
评估与不同腰椎融合手术相关的住院期间多模式镇痛（MME）管理。
年龄≥18岁，诊断为I级或II级椎体滑脱、椎管狭窄、椎间盘退变或椎弓根峡部裂，通过传统微创、前后位或单入路在L2 - S1之间接受单节段经椎间孔腰椎椎间融合术（TLIF）、单节段前路腰椎椎间融合术（ALIF）或外侧腰椎椎间融合术（LLIF）治疗的患者。观察指标包括患者人口统计学资料、手术方式和入路、围手术期临床特征、肠梗阻发生率和住院期间MME。统计分析包括采用事后Tukey检验的单因素方差分析以及采用事后Mann - Whitney检验的Kruskal - Wallis检验。MME根据医疗保险和医疗补助服务中心及既往文献进行计算。显著性设定为<0.05。
微创TLIF组（55.6±12.5岁）与所有其他组（开放TLIF组57.1±12.5岁、单纯后路ALIF/LLIF组57.9±9.9岁、经皮前路ALIF/LLIF组50.9±12.7岁、开放ALIF/LLIF组58.4±15.5岁）的平均年龄存在显著差异。与除单纯后路ALIF/LLIF组外的所有组相比，微创TLIF组的住院时间最短。微创TLIF组与开放ALIF/LLIF组（172.5 MME对261.1 MME，P = 0.044）以及微创TLIF组与经皮前路ALIF/LLIF组（172.5 MME对245.4 MME，P = 0.009）之间的总MME存在显著差异。所有组之间每小时MME和肠梗阻发生率无显著差异。
与经皮和单纯后路ALIF/LLIF组相比，接受微创TLIF手术的患者住院期间阿片类药物摄入量更低，与除单纯后路ALIF/LLIF组外的所有组相比住院时间更短。因此，微创TLIF似乎体现了微创手术的优势。
