单节段、开放、后路腰椎融合术中，经椎间孔腰椎体间融合术与经椎间孔椎体间融合术相比，哪种方法的疗效更好？

In Single-Level, Open, Posterior Lumbar Fusion, Does Transforaminal Lumbar Interbody Fusion or Posterolateral Fusion Lead to Better Outcomes?

机构信息

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

Neurosurgery. 2023 Jan 1;92(1):110-117. doi: 10.1227/neu.0000000000002187. Epub 2022 Nov 1.

DOI:10.1227/neu.0000000000002187

PMID:36519862

Abstract

BACKGROUND

Two common approaches for open, one-level, posterior lumbar fusions include transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) alone without an interbody.

OBJECTIVE

To compare TLIF vs PLF alone in (1) discharge disposition, (2) return to work (RTW), and (3) patient-reported outcomes (PROs).

METHODS

A single-center, retrospective cohort study was undertaken between October 2010 and May 2021, all with a 1-year follow-up and excluding patients with isthmic spondylolisthesis. Minimum clinically important difference for each PRO was used, which included Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Logistic/linear regression controlled for age, body mass index, disc height, flexion-extension movement, amount of movement on flexion-extension, and spondylolisthesis grade.

RESULTS

Of 850 patients undergoing open, 1-level, posterior lumbar fusion, 591 (69.5%) underwent a TLIF and 259 (30.5%) underwent a PLF alone. Patients undergoing TLIF were younger (59.0 ± 11.3 vs 63.3 ± 12.6, P < .001), had higher body mass index (31.3 ± 6.6 vs 30.2 ± 12.6, P = .019), and more often had private insurance (50.3% vs 39.0%, P < .001). Regarding discharge disposition, no significance was found in multivariate regression (odds ratio = 2.07, 95% CI = 0.39-10.82, P = .385) with similar RTW between TLIF and PLF alone (80.8% vs 80.4%, P = .645) (odds ratio = 1.15, 95% CI = 0.19-6.81, P = .873). Regarding PROs, patients undergoing a TLIF had higher preoperative (6.7 ± 2.3 vs 6.4 ± 2.5, P = .046) and 3-month NRS-back pain (3.4 ± 2.6 vs 2.9 ± 2.5, P = .036), with similar 12-month NRS-back pain. Regarding NRS-leg pain, no differences were observed preoperatively ( P = .532) and at 3 months ( P = .808). No other significant differences were observed in ODI.

CONCLUSION

TLIF patients had slightly higher NRS-back pain at baseline and 3 months, but similar NRS-leg pain, despite the added risk of placing an interbody. No differences were seen in discharge disposition, RTW, and 12-month pain scores and ODI.

摘要

背景

后路开放、单节段腰椎融合术有两种常用方法，包括经椎间孔腰椎间融合术（TLIF）和单纯后路融合术（PLF），不使用椎间融合器。

目的

比较 TLIF 与单纯 PLF 在（1）出院去向、（2）重返工作岗位（RTW）和（3）患者报告的结果（PROs）方面的差异。

方法

这是一项单中心、回顾性队列研究，于 2010 年 10 月至 2021 年 5 月进行，所有患者均随访 1 年，不包括峡部裂性脊椎滑脱患者。使用了每个 PRO 的最小临床重要差异，包括数字评分量表（NRS）和 Oswestry 残疾指数（ODI）。逻辑/线性回归控制了年龄、体重指数、椎间盘高度、屈伸运动、屈伸运动的活动度以及脊椎滑脱程度。

结果

在 850 例接受后路开放、单节段腰椎融合术的患者中，591 例（69.5%）接受 TLIF 治疗，259 例（30.5%）接受单纯 PLF 治疗。接受 TLIF 的患者更年轻（59.0 ± 11.3 岁 vs 63.3 ± 12.6 岁，P <.001），体重指数更高（31.3 ± 6.6 岁 vs 30.2 ± 12.6 岁，P =.019），且更常拥有私人保险（50.3% vs 39.0%，P <.001）。在多变量回归中，出院去向无显著差异（比值比=2.07，95%CI=0.39-10.82，P =.385），TLIF 与单纯 PLF 术后 RTW 相似（80.8% vs 80.4%，P =.645）（比值比=1.15，95%CI=0.19-6.81，P =.873）。关于 PROs，接受 TLIF 的患者术前（6.7 ± 2.3 分 vs 6.4 ± 2.5 分，P =.046）和术后 3 个月（3.4 ± 2.6 分 vs 2.9 ± 2.5 分，P =.036）的 NRS 腰痛评分更高，而 12 个月时的 NRS 腰痛评分无差异。在 NRS 腿痛方面，术前无显著差异（P =.532），术后 3 个月时也无显著差异（P =.808）。ODI 也未见其他显著差异。