Zhou Tianyao, Fan Wenshuai, Gu Yutong, Che Wu, Zhang Liang, Wang Yichao
Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
Department of Orthopaedic Surgery, Shanghai Southwest Spine Surgery Center, Shanghai, China.
Front Surg. 2023 Jan 6;9:1049448. doi: 10.3389/fsurg.2022.1049448. eCollection 2022.
Oblique lumbar interbody fusion (OLIF) has been used to treat lumbar spine spondylolisthesis. However, it usually needs posterior pedicle screws fixation for biomechanical stability and possible posterior direct decompression for relieving neurologic symptoms. We use percutaneous transforaminal endoscopic surgery (PTES) combined with mini-incision OLIF and anterolateral screws rod fixation for surgical treatment of lumbar spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy, and safety of this method compared with minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).
From July 2016 to May 2018, 65 patients of lumbar spondylolisthesis (L2-4) with neurologic symptoms were treated using PTES combined with mini-incision OLIF and anterolateral screws rod fixation (31 cases, group A) or MIS-TLIF (34 cases, group B) in this study. Operative duration, blood loss, incision length, fluoroscopy frequency, and hospital stay are compared. Preoperative and postoperative visual analog scale (VAS) pain scores of back and legs, Oswestry disability index (ODI), intervertebral space height, lumbar lordotic angle, operative segmental lordotic angle, and complications are recorded. The fusion status is assessed according to Bridwell's fusion grades.
The VAS score of back and leg pain and ODI significantly dropped after surgery in both groups ( < 0.001). There was no statistical difference of back and leg VAS score and ODI between two groups except that back VAS scores in group A were significantly lower than that of group B immediately after surgery ( = 0.000). Group A had significantly more intervertebral space height and operative segmental lordotic angle than group B postoperatively ( = 0.022, = 0.002). Twenty-three segments (74.2%) were grade I and 8 segments (25.8%) were grade II in group A; 20 segments (58.8%) were grade I and 14 segments (41.2%) were grade II in group B at a 2-year follow-up ( = 0.194). No difference was observed in the complication rate between the two groups (6.5% vs. 5.9%, = 0.924).
The long-term clinical efficacy and complication rates of both groups are comparable. PTES combined with mini-incision OLIF and anterolateral screws rod fixation is a good choice of minimally invasive surgery for lumbar spondylolisthesis, which hardly destroys the paraspinal muscles and bone structures.
斜外侧腰椎椎间融合术（OLIF）已用于治疗腰椎滑脱症。然而，它通常需要后路椎弓根螺钉固定以获得生物力学稳定性，并可能需要后路直接减压以缓解神经症状。我们采用经皮椎间孔镜手术（PTES）联合小切口OLIF及前外侧螺钉棒固定治疗腰椎滑脱症。本研究的目的是评估该方法与微创经椎间孔腰椎椎间融合术（MIS-TLIF）相比的可行性、有效性和安全性。
2016年7月至2018年5月，本研究中65例有神经症状的腰椎滑脱症（L2-4）患者采用PTES联合小切口OLIF及前外侧螺钉棒固定治疗（31例，A组）或MIS-TLIF治疗（34例，B组）。比较手术时间、失血量、切口长度、透视次数和住院时间。记录术前和术后背部和腿部的视觉模拟评分（VAS）疼痛评分、Oswestry功能障碍指数（ODI）、椎间隙高度、腰椎前凸角、手术节段前凸角及并发症。根据Bridwell的融合分级评估融合状态。
两组术后背部和腿部疼痛的VAS评分及ODI均显著下降（<0.001）。两组间背部和腿部VAS评分及ODI无统计学差异，但A组术后即刻背部VAS评分显著低于B组（=0.000）。术后A组椎间隙高度及手术节段前凸角显著高于B组（=0.022，=0.002）。随访2年时，A组23个节段（74.2%）为I级，8个节段（25.8%）为II级；B组20个节段（58.8%）为I级，14个节段（41.2%）为II级（=0.194）。两组并发症发生率无差异（6.5%对5.9%，=0.924）。
两组的长期临床疗效和并发症发生率相当。PTES联合小切口OLIF及前外侧螺钉棒固定是治疗腰椎滑脱症的一种较好的微创手术选择，对椎旁肌肉和骨结构破坏较小。
