Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
Neurosurg Rev. 2022 Oct;45(5):3417-3426. doi: 10.1007/s10143-022-01845-w. Epub 2022 Sep 6.
Instrumented stabilization with intersomatic fusion can be achieved by open (O-TLIF) or minimally invasive (MIS-TLIF) transforaminal surgical access. While less invasive techniques have been associated with reduced postoperative pain and disability, increased manipulation and insufficient decompression may contradict MIS techniques. In order to detect differences between both techniques in the short-term, a prospective, controlled study was conducted. Thirty-eight patients with isthmic or degenerative spondylolisthesis or degenerative disk disease were included in this prospective, controlled study (15 MIS-TLIF group vs. 23 O-TLIF group) after failed conservative treatment. Patients were examined preoperatively, on the first, third, and sixth postoperative day as well as after 2, 4, and 12 weeks postoperatively. Outcome parameters included blood loss, duration of surgery, pre- and postoperative pain (numeric rating scale [NRS], visual analog scale [VAS]), functionality (Timed Up and Go test [TUG]), disability (Oswestry Disability index [ODI]), and quality of life (EQ-5D). Intraoperative blood loss (IBL) as well as postoperative blood loss (PBL) was significantly higher in the O-TLIF group ([IBL O-TLIF 528 ml vs. MIS-TLIF 213 ml, p = 0.001], [PBL O-TLIF 322 ml vs. MIS-TLIF 30 ml, p = 0.004]). The O-TLIF cohort showed significantly less leg pain postoperatively compared to the MIS-TLIF group ([NRS leg 3rd postoperative day, p = 0.027], [VAS leg 12 weeks post-op, p = 0.02]). The MIS group showed a significantly better improvement in the overall ODI (40.8 ± 13 vs. 56.0 ± 16; p = 0.05). After 3 months in the short-term follow-up, the MIS procedure tends to have better results in terms of patient-reported quality of life. MIS-TLIF offers perioperative advantages but may carry the risk of increased nerve root manipulation with consecutive higher radicular pain, which may be related to the learning curve of the procedure.
经皮固定融合术可以通过开放（O-TLIF）或微创（MIS-TLIF）经椎间孔入路实现。虽然微创技术与术后疼痛和残疾减轻相关，但增加的操作和不足的减压可能与 MIS 技术相矛盾。为了在短期内检测到两种技术之间的差异，进行了一项前瞻性、对照研究。38 例峡部或退行性腰椎滑脱或退行性椎间盘疾病患者纳入本前瞻性、对照研究（15 例 MIS-TLIF 组与 23 例 O-TLIF 组），均为保守治疗失败后。患者在术前、术后第 1、3 和 6 天以及术后 2、4 和 12 周进行检查。观察指标包括出血量、手术时间、术前和术后疼痛（数字评分量表[NRS]、视觉模拟量表[VAS]）、功能（计时起立行走测试[TUG]）、残疾（Oswestry 残疾指数[ODI]）和生活质量（EQ-5D）。O-TLIF 组术中出血量（IBL）和术后出血量（PBL）明显高于 MIS-TLIF 组（[IBL O-TLIF 528ml 比 MIS-TLIF 213ml，p=0.001]，[PBL O-TLIF 322ml 比 MIS-TLIF 30ml，p=0.004]）。与 MIS-TLIF 组相比，O-TLIF 组术后腿痛明显减轻（[第 3 天腿部 NRS，p=0.027]，[12 周腿部 VAS，p=0.02]）。MIS 组的 ODI 整体改善明显更好（40.8±13 比 56.0±16；p=0.05）。在短期随访的 3 个月内，MIS 手术在患者报告的生活质量方面具有更好的结果。MIS-TLIF 具有围手术期优势，但可能存在神经根操作增加的风险，导致根性疼痛增加，这可能与该手术的学习曲线有关。
