Bovonratwet Patawut, Samuel Andre M, Mok Jung Kee, Vaishnav Avani S, Morse Kyle W, Song Junho, Steinhaus Michael E, Jordan Yusef J, Gang Catherine H, Qureshi Sheeraz A
Department of Orthopaedic Surgery, Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2022 Nov 1;47(21):1505-1514. doi: 10.1097/BRS.0000000000004432. Epub 2022 Jul 15.
A retrospective cohort comparison study.
To compare perioperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs) between minimally invasive unilateral laminotomy with bilateral decompression (MIS-ULBD) versus MIS transforaminal lumbar interbody fusion (MIS-TLIF) for treatment of low-grade lumbar degenerative spondylolisthesis.
While lumbar degenerative spondylolisthesis is a common condition, optimal surgical treatment remains controversial. Newer MIS techniques, which preserve bone, paraspinal musculature, and posterior midline stabilizers, are thought to reduce the risk of iatrogenic instability and may obviate the need for fusion. However, few comparative studies of MIS techniques for low-grade lumbar degenerative spondylolisthesis currently exist.
Consecutive patients with low-grade (Meyerding grade I or II) lumbar degenerative spondylolisthesis treated with single-level MIS-ULBD or MIS-TLIF were identified retrospectively from a prospectively collected spine surgery registry from April 2017 to November 2021. Perioperative outcomes, radiographic data, and PROMs were assessed.
A total of 188 patients underwent either MIS-ULBD or MIS-TLIF (79 MIS-ULBD and 109 MIS-TLIF). Patients who underwent MIS-ULBD tended to be older, had higher Charlson Comorbidity Index, lower mean percentage back pain, higher percentage of L4/L5 pathology, shorter operative time, lower estimated blood loss, and lower postoperative pain ( P <0.05). In both groups, there were statistically significant improvements at one year for five of the six PROMs studied: Oswestry Disability Index (ODI), visual analog scale (VAS)-back pain, VAS-leg pain, Short Form 12 Physical Component Score (SF12-PCS), and Patient-Reported Outcomes Measurement Information System (PROMIS) ( P <0.05). On multivariate analysis controlling for confounders, there were no associations between procedure type and achieving minimal clinically important difference at one year in any of the PROMs studied.
The current study suggests that both MIS-ULBD and MIS-TLIF result in significant improvements in pain and physical function for patients with low-grade lumbar degenerative spondylolisthesis.
一项回顾性队列比较研究。
比较微创单侧椎板切开双侧减压术（MIS-ULBD）与微创经椎间孔腰椎椎间融合术（MIS-TLIF）治疗低度腰椎退行性滑脱的围手术期结果、影像学参数和患者报告的结局指标（PROMs）。
虽然腰椎退行性滑脱是一种常见疾病，但最佳手术治疗方案仍存在争议。新的微创技术能够保留骨质、椎旁肌肉组织和后中线稳定结构，被认为可降低医源性不稳定的风险，且可能无需进行融合手术。然而，目前针对低度腰椎退行性滑脱的微创技术的比较研究较少。
从2017年4月至2021年11月前瞻性收集的脊柱手术登记册中，回顾性识别接受单节段MIS-ULBD或MIS-TLIF治疗的连续低度（迈耶丁I级或II级）腰椎退行性滑脱患者。评估围手术期结果、影像学数据和PROMs。
共有188例患者接受了MIS-ULBD或MIS-TLIF手术（79例MIS-ULBD和109例MIS-TLIF）。接受MIS-ULBD手术的患者往往年龄较大，Charlson合并症指数较高，平均背痛百分比较低，L4/L5病变百分比较高，手术时间较短，估计失血量较低，术后疼痛较轻（P<0.05）。在两组中，所研究的六个PROMs中的五个在术后一年有统计学显著改善：Oswestry功能障碍指数（ODI）、视觉模拟量表（VAS）背痛评分、VAS腿痛评分、简明健康调查12项身体成分评分（SF12-PCS）和患者报告结局测量信息系统（PROMIS）（P<0.05）。在控制混杂因素的多变量分析中，手术类型与所研究的任何PROMs在术后一年达到最小临床重要差异之间均无关联。
当前研究表明，MIS-ULBD和MIS-TLIF均能使低度腰椎退行性滑脱患者的疼痛和身体功能得到显著改善。
3级。
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