Department of Orthopaedic and Spinal Surgery, Aizu Medical Center at Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan.
Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Clin Interv Aging. 2023 Jan 31;18:131-139. doi: 10.2147/CIA.S385317. eCollection 2023.
To investigate whether the minimally invasive spinal fusion can provide the better outcome than conventional fusion surgery in the treatment of degenerative lumbar spinal diseases.
One hundred and thirteen patients who had undergone single-level fusion surgery for degenerative lumbar spinal diseases were examined with a minimum of one-year follow-up. There were 56 men and 57 women with a median age of 70s ranging 47-88. The following three-types of fusion surgery were performed; minimally invasive transforaminal interbody fusion after microscopic decompression through a unilateral approach with percutaneous pedicle screwing (MTLIF), transforaminal interbody fusion after microscopic decompression through a unilateral approach (TLIF), and posterior lumbar interbody fusion with posterolateral fusion after open decompression through a bilateral approach (PLIF). The purpose for limiting on single level degenerative spinal disease was that it would be easy to compare the surgical outcomes among the three groups.
There were no statistically significant differences among three groups in terms of VAS scores, RDQ scores, and all of the domains in the JOABPEQ scores at the baseline. The JOABPEQ score for pain-related disorders at 6 months after surgery was statistically significantly higher in MTLIF group than the other two groups (P = 0.023). There were no statistically significant differences in the scores of the other outcome measures among three groups in whole follow-up period.
The current study demonstrated that the JOABPEQ score for pain-related disorders at 6 months postoperatively was significantly better in MTLIF group than in the other groups. Since lumbar degenerative diseases mostly consisted in elderly patients, less invasive surgeries are desirable. MTLIF resulted in a better health-related QOL at 6 months after surgery, and its outcomes at the final follow-up were non-numerical inferiority. The results strongly indicate that MTLIF is desirable surgery especially for elderly patients with degenerative spinal diseases.
研究微创脊柱融合术与传统融合手术治疗退行性腰椎疾病的疗效。
对 113 例行单节段融合术治疗退行性腰椎疾病的患者进行了检查，随访时间至少为 1 年。患者中有 56 名男性和 57 名女性，中位年龄为 70 岁（范围为 47-88 岁）。共进行了三种类型的融合手术：单侧入路经皮椎弓根螺钉微创减压后路经椎间孔融合术（MTLIF）、单侧入路经皮椎弓根螺钉微创减压后路经椎间孔融合术（TLIF）和双侧入路开放减压后路经椎间孔融合术（PLIF）。限制在单节段退行性脊柱疾病的目的是便于比较三组手术结果。
三组患者在基线时的 VAS 评分、RDQ 评分和 JOABPEQ 评分的所有领域均无统计学差异。MTLIF 组术后 6 个月 JOABPEQ 评分中与疼痛相关的障碍评分明显高于其他两组（P=0.023）。在整个随访期间，三组患者在其他评估指标的评分方面无统计学差异。
本研究表明，MTLIF 组术后 6 个月 JOABPEQ 评分中与疼痛相关的障碍评分明显优于其他两组。由于腰椎退行性疾病主要发生在老年患者中，因此微创手术是理想的选择。MTLIF 术后 6 个月时，健康相关生活质量明显改善，最终随访时的结果为非数值性劣效。这些结果强烈表明，MTLIF 是退行性脊柱疾病老年患者的理想手术选择。
