Gagliardi Martin J, Guiroy Alfredo J, Camino-Willhuber Gaston, Joaquim Andrei F, Carazzo Charles A, Yasuda Ezequiel, Cabrera Juan P, Morales Ciancio Alejandro R
Department of Neurosurgery, 10071St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Department of Orthopedics, Hospital Español de Mendoza, Mendoza, Argentina.
Global Spine J. 2023 Mar;13(2):499-511. doi: 10.1177/21925682221098362. Epub 2022 Apr 29.
Systematic Review and Meta-analysis. Surgical alternatives to treat lumbar spinal stenosis and instability include indirect (ALIF, OLIF, and LLIF) and direct (TLIF or posterior lumbar interbody fusion) decompression and fusion interventions. Although both approaches have proven to be effective in reducing symptoms, it is unknown if there is any difference in effectiveness between them. In this systematic review and meta-analysis, we aimed to evaluate postoperative pain and disability in patients treated whit indirect vs direct decompression and fusion approaches. We conducted a systematic review of the literature consulting several databases and identified studies that enrolled patients diagnosed with degenerative lumbar spinal stenosis and instability treated with indirect or direct decompression and fusion techniques. Our primary endpoints were the visual analogue scale, Oswestry Disability Index, and the Japanese Orthopedics Association Back Pain Evaluation Questionnaire 1 year after the procedure. Secondary outcomes included complication rate, blood loss, and surgical time. Nine retrospective and comparative studies were included enrolling a total of 1004 participants. Both surgical strategies had satisfactory clinical outcomes with no significant difference at 1 year. Although the complication rate was similar for both groups, the profile of the adverse events was different. In addition, patients treated with indirect decompression and fusion had significantly less blood loss and operative times. Indirect and direct decompression and fusion techniques are similarly effective in treating patients with lumbar spinal stenosis and instability. The ID group had significantly lower intraoperative blood loss and surgical time values.
系统评价与荟萃分析。治疗腰椎管狭窄症和腰椎不稳的手术替代方案包括间接减压融合术（前路腰椎椎间融合术、斜外侧腰椎椎间融合术和侧方腰椎椎间融合术）和直接减压融合术（经椎间孔腰椎椎体间融合术或后路腰椎椎间融合术）。尽管这两种方法在减轻症状方面均已被证明有效，但它们在有效性上是否存在差异尚不清楚。在这项系统评价与荟萃分析中，我们旨在评估采用间接减压融合术与直接减压融合术治疗的患者术后的疼痛和功能障碍情况。我们对多个数据库进行文献检索，开展了一项系统评价，并确定了纳入诊断为退行性腰椎管狭窄症和腰椎不稳且接受间接或直接减压融合技术治疗患者的研究。我们的主要终点指标是术后1年的视觉模拟评分、Oswestry功能障碍指数和日本骨科学会腰痛评估问卷。次要结局包括并发症发生率、失血量和手术时间。共纳入9项回顾性比较研究，总计1004名参与者。两种手术策略均取得了满意的临床疗效，1年时无显著差异。尽管两组并发症发生率相似，但不良事件的情况有所不同。此外，接受间接减压融合术治疗的患者失血量和手术时间明显更少。间接减压融合术和直接减压融合术在治疗腰椎管狭窄症和腰椎不稳患者方面同样有效。间接减压融合术组术中失血量和手术时间值显著更低。
