Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, P.R. China.
Department of Cardiovascular Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, P.R. China.
PLoS One. 2023 Feb 6;18(2):e0280135. doi: 10.1371/journal.pone.0280135. eCollection 2023.
Adjacent segment disease (ASD) is a common complication after lumbar fusion and is still traditionally treated by open surgery. In recent years, with the development of minimally invasive techniques, percutaneous endoscopic surgery(PES) has been used for the treatment of ASD after lumbar fusion due to its unique benefits. Nevertheless, it remains unclear about its significant clinical efficacy and advantages over conventional open surgery.
To evaluate the clinical efficacy and safety of PES in the treatment of ASD after lumbar fusion.
A systematic review and meta-analysis studies about the role of PES in managing ASD after lumbar fusion.
A systematic search review was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP, WanFang, and SinoMed databases from the start of their construction to 15 November 2021. Eligible studies included references to clinical trials of PES for ASD after open lumbar fusion. Observations included pain relief, recovery of postoperative function, overall excellent rates, and indicators of the advantages of minimally invasive surgery compared to conventional surgery. Postoperative complications and recurrence rates were also recorded.
A total of 24 studies, including 20 single-arm studies and 4 clinical control studies, all involving 928 patients were included. A total of 694 patients were included in the single-arm analysis. The results of the single-arm meta-analysis showed that PES could significantly reduce low back and leg pain and improve the functional status of the lumbar spine in patients with ASD after open lumbar fusion compared to preoperatively, and had good clinical efficacy after surgery. A total of 234 patients were included in the four clinically controlled studies, and the results of the meta-analysis showed that PES could clearly reduce pain and improve lumbar function, with no significant difference in efficacy between PES and open surgery. However, PES has a lower surgical incision, less intraoperative bleeding, and shorter operative time and length of hospital stay compared to open surgery. Moreover, it has a lower rate of postoperative recurrence as well as complications and a longer duration of efficacy.
On the basis of the available clinical literature and the results of this study, PES could achieve satisfactory clinical effects in ASD treatment after lumbar fusion. Compared with conventional open surgery, PES can not only obtain similar clinical results, but also had the advantages of less trauma and faster recovery. Nevertheless, a randomized controlled study is still needed to validate the findings of this study.
Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022298387.
邻近节段疾病（ASD）是腰椎融合术后的常见并发症，传统上仍采用开放手术治疗。近年来，随着微创技术的发展，经皮内镜手术（PES）因其独特的优势已被用于治疗腰椎融合术后 ASD。然而，其与传统开放手术相比的显著临床疗效和优势仍不明确。
评估 PES 在治疗腰椎融合术后 ASD 中的临床疗效和安全性。
对 PES 在治疗腰椎融合术后 ASD 中的作用进行系统评价和荟萃分析研究。
系统检索 PubMed、EMBASE、Cochrane 图书馆、Web of Science、CNKI、VIP、WanFang 和 SinoMed 数据库，从建库开始至 2021 年 11 月 15 日。纳入研究为经皮内镜手术治疗开放腰椎融合术后 ASD 的临床试验。观察指标包括疼痛缓解、术后功能恢复、总体优良率以及与传统手术相比微创手术的优势指标。还记录了术后并发症和复发率。
共纳入 24 项研究，包括 20 项单臂研究和 4 项临床对照研究，共纳入 928 例患者。单臂分析共纳入 694 例患者。单臂荟萃分析结果显示，与术前相比，经皮内镜手术后 ASD 患者的腰痛和腿痛明显减轻，腰椎功能状态改善，术后临床疗效良好。4 项临床对照研究共纳入 234 例患者，荟萃分析结果显示，经皮内镜手术和开放手术均可明显减轻疼痛，改善腰椎功能，两组疗效无显著差异。然而，与开放手术相比，经皮内镜手术的手术切口更小，术中出血量更少，手术时间和住院时间更短，且术后复发率以及并发症发生率更低，疗效持续时间更长。
基于现有临床文献和本研究结果，经皮内镜手术可在腰椎融合术后 ASD 治疗中获得满意的临床效果。与传统开放手术相比，经皮内镜手术不仅能获得相似的临床效果，还具有创伤小、恢复快的优势。然而，仍需要随机对照研究来验证本研究的结果。
系统评价注册：https://www.crd.york.ac.uk/prospero/，标识符 CRD42022298387。
