与传统后路手术相比，单侧双通道内镜下腰椎椎间融合术可促进腰椎退行性疾病患者的恢复：一项系统评价与Meta分析

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis.

作者信息

Yang Honghao, Cheng Fengqi, Hai Yong, Liu Yuzeng, Pan Aixing

机构信息

Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Beijing, China.

出版信息

Front Neurol. 2023 Jan 10;13:1089981. doi: 10.3389/fneur.2022.1089981. eCollection 2022.

DOI:10.3389/fneur.2022.1089981

PMID:36703632

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9871470/

Abstract

BACKGROUND

Minimally invasive endoscopic technique is an important component of Enhanced Recovery After Surgery (ERAS) protocol for neurosurgery. In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has been used in the treatment of lumbar degenerative diseases (LDD). This study aims to investigate whether ULIF could enhance the recovery of patients with LDD compared with the conventional minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or posterior lumbar interbody fusion (PLIF).

METHODS

A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, Cochrane Library database, China National Knowledge Internet, and Wanfang database. Surgical data, clinical outcomes, radiographic outcomes, and surgical complications were compared between patients with LDD who underwent ULIF and those who underwent conventional MI-TLIF or PLIF.

RESULTS

Notably, 12 studies, comprising 981 patients with LDD, were included. Of these patients, 449 underwent ULIF and 532 patients (355 MI-TLIF and 177 PLIF) were treated with conventional procedures. There was no significant difference in the fusion rate, cage subsidence rate, and surgical complications between the ULIF group and the MI-TLIF or PLIF group. Compared with MI-TLIF, the ULIF group presented a significantly reduced estimated blood loss (EBL) (WMD, -106.00; 95% CI -140.99 to -71.10, < 0.001) and shorter length of hospital stay (LOS) (WMD, -1.27; 95% CI -1.88 to -0.66, < 0.001); better short-term improvement in ODI (WMD, -2.12; 95% CI -3.53 to -0.72, = 0.003) and VAS score for back pain (VAS-BP) (WMD, -0.86; 95% CI -1.15 to -0.58, < 0.001) at 1 month post-operatively. Compared with PLIF, the ULIF group presented a significantly reduced EBL (WMD, -149.22; 95% CI -284.98 to -13.47, = 0.031) and shorter LOS (WMD, -4.40; 95% CI -8.04 to -0.75, = 0.018); better short-term improvement in VAS-BP (WMD, -1.07; 95% CI -1.77 to -0.38, = 0.002) and VAS score for leg pain (VAS-LP) (WMD, -0.40; 95% CI -0.72 to -0.08, = 0.014) at 1-2 week post-operatively; enhanced short- and long-term improvement in ODI at 1 month post-operatively (WMD, -3.12; 95% CI -5.72 to -0.53, = 0.018) and the final follow-up (WMD, -1.97; 95% CI -3.32 to -0.62, = 0.004), respectively.

CONCLUSION

Compared with conventional MI-TLIF and PLIF, ULIF was associated with reduced EBL, shorter LOS, and comparable fusion rate as well as complication management. Compared with MI-TLIF, a better short-term improvement in VAS-BP and ODI was achieved by ULIF; compared with open PLIF, additional enhanced short-term improvement in VAS-LP and long-term improvement in ODI were observed in ULIF. ULIF could enhance the recovery of patients with LDD compared with conventional posterior procedures.

SYSTEMATIC TRIAL REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230695, CRD42021230695.

摘要

背景

微创内镜技术是神经外科手术加速康复（ERAS）方案的重要组成部分。近年来，单侧双孔道内镜下腰椎椎间融合术（ULIF）已用于治疗腰椎退行性疾病（LDD）。本研究旨在探讨与传统的微创经椎间孔腰椎椎间融合术（MI-TLIF）或后路腰椎椎间融合术（PLIF）相比，ULIF是否能促进LDD患者的恢复。

方法

在PubMed、EMBASE、Web of Science、Cochrane图书馆数据库、中国知网和万方数据库中对相关研究进行全面的文献检索。比较接受ULIF的LDD患者与接受传统MI-TLIF或PLIF的患者之间的手术数据、临床结局、影像学结局和手术并发症。

结果

值得注意的是，纳入了12项研究，共981例LDD患者。其中，449例行ULIF，532例患者（355例行MI-TLIF，177例行PLIF）接受传统手术治疗。ULIF组与MI-TLIF或PLIF组在融合率、椎间融合器下沉率和手术并发症方面无显著差异。与MI-TLIF相比，ULIF组的估计失血量（EBL）显著减少（加权均数差[WMD]，-106.00；95%可信区间[-140.99，-71.10]，P<0.001），住院时间（LOS）缩短（WMD，-1.27；95%可信区间[-1.88，-0.66]，P<0.001）；术后1个月时，ODI（WMD，-2.12；95%可信区间[-3.53，-0.72]，P=0.003）和背痛视觉模拟评分（VAS-BP）（WMD，-0.86；95%可信区间[-1.15，-0.58]，P<0.001）的短期改善更好。与PLIF相比，ULIF组的EBL显著减少（WMD，-149.22；95%可信区间[-284.98，-13.47]，P=0.031），LOS缩短（WMD，-4.40；95%可信区间[-8.04，-0.75]，P=0.018）；术后1-2周时，VAS-BP（WMD，-1.07；95%可信区间[-1.77，-0.38]，P=0.002）和腿痛视觉模拟评分（VAS-LP）（WMD，-0.40；95%可信区间[-0.72，-0.08]，P=0.014）的短期改善更好；术后1个月（WMD，-3.12；95%可信区间[-5.72，-0.53]，P=0.018）和末次随访（WMD，-1.97；95%可信区间[-3.32，-0.62]，P=0.004）时，ODI的短期和长期改善均增强。

结论

与传统的MI-TLIF和PLIF相比，ULIF与EBL减少、LOS缩短相关，融合率和并发症处理相当。与MI-TLIF相比，ULIF在VAS-BP和ODI方面实现了更好的短期改善；与开放PLIF相比，ULIF在VAS-LP方面有额外的短期改善，在ODI方面有长期改善。与传统后路手术相比，ULIF可促进LDD患者的恢复。