Orthopedics Department, Bangkok, Thailand; Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand; Mahidol University, Bangkok, Thailand.
Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
World Neurosurg. 2022 Sep;165:e282-e291. doi: 10.1016/j.wneu.2022.06.029. Epub 2022 Jun 13.
Lateral lumbar interbody fusion (LLIF) and percutaneous posterior screw fixation (PPSF) techniques is used to treat degenerative lumbar pathologies. Dual-position (DP) lumbar surgery involves repositioning the patient from the supine or lateral decubitus position to prone for posterior fixation. Single-position (SP) lumbar surgery is commonly performed nowadays, a minimally invasive alternative performed entirely from the lateral decubitus position. However, controversy still exists. This meta-analysis aimed to compare perioperative outcomes between SP lumbar surgery and DP lumbar surgery for LLIF and PPSF.
We conducted this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched Medline and Scopus from inception to November 11, 2021, for relevant studies.
Six studies were identified, which contained totals of 502 and 447 patients in the SP and DP groups, respectively. The unstandardized mean difference in operative time, length of hospital stay, intraoperative blood loss, radiation doses, lumbar lordosis, and pelvic incidence-lumbar lordosis mismatch were -86.1 (95% confidence interval [CI] -149.2 to -23.1) minutes, -1.6 (95% CI -2.4 to -0.9) days, -55.6 (95% CI -127.5 to 16.2) mL, -30.3 (95% CI -80.5 to 19.8) mGy, 1.34 (95% CI -1.17 to 3.86) degrees, and -4.06 (95% CI -5.65 to -2.47) lower in SP when compared with DP. The chances of having complications and reoperations in SP were 0.75 (95% CI 0.49-1.14) and 0.77 (95% CI 0.44-1.36) times, respectively, compared with the DP group. No significant differences were found for intraoperative blood loss, radiation dose, lumbar lordosis, complications, and reoperations between the 2 groups.
This meta-analysis found that SP have lower operative time and length of hospital stay compared with DP LLIF and PPSF. However, no differences in intraoperative blood loss, radiation dose, radiographic change, complications, and reoperation rates were found.
经皮侧方腰椎间融合术（LLIF）和经皮后路螺钉固定术（PPSF）用于治疗退行性腰椎病变。双体位（DP）腰椎手术需要将患者从仰卧位或侧卧位重新定位到俯卧位进行后路固定。单体位（SP）腰椎手术是目前常用的微创手术，可完全从侧卧位进行。然而，目前仍存在争议。本荟萃分析旨在比较 SP 腰椎手术与 DP 腰椎手术在 LLIF 和 PPSF 中的围手术期结果。
我们根据系统评价和荟萃分析的首选报告项目指南进行了这项荟萃分析，并从 1970 年 1 月至 2021 年 11 月 11 日在 Medline 和 Scopus 上搜索了相关研究。
共确定了 6 项研究，其中 SP 组和 DP 组分别包含 502 例和 447 例患者。手术时间、住院时间、术中失血量、辐射剂量、腰椎前凸角和骨盆入射角-腰椎前凸角不匹配的标准化均数差值分别为-86.1（95%置信区间 [CI] -149.2 至 -23.1）分钟、-1.6（95% CI -2.4 至 -0.9）天、-55.6（95% CI -127.5 至 16.2）毫升、-30.3（95% CI -80.5 至 19.8）mGy、1.34（95% CI -1.17 至 3.86）度和-4.06（95% CI -5.65 至 -2.47）度，SP 时与 DP 相比。SP 组发生并发症和再次手术的几率分别为 0.75（95% CI 0.49-1.14）和 0.77（95% CI 0.44-1.36），低于 DP 组。两组之间术中失血量、辐射剂量、腰椎前凸角、并发症和再次手术率无显著差异。
本荟萃分析发现，与 DP LLIF 和 PPSF 相比，SP 的手术时间和住院时间更短。然而，术中失血量、辐射剂量、影像学变化、并发症和再手术率无差异。
