Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Neurosurgery. 2023 Jul 1;93(1):186-197. doi: 10.1227/neu.0000000000002402. Epub 2023 Feb 24.
Transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) alone are two operations performed to treat degenerative lumbar spondylolisthesis. To date, it is unclear which operation leads to better outcomes.
To compare TLIF vs PLF alone regarding long-term reoperation rates, complications, and patient-reported outcome measures (PROMs) in patients with degenerative grade 1 spondylolisthesis.
A retrospective cohort study using prospectively collected data between October 2010 and May 2021 was undertaken. Inclusion criteria were patients aged 18 years or older with grade 1 degenerative spondylolisthesis undergoing elective, single-level, open posterior lumbar decompression and instrumented fusion with ≥1-year follow-up. The primary exposure was presence of TLIF vs PLF without interbody fusion. The primary outcome was reoperation. Secondary outcomes included complications, readmission, discharge disposition, return to work, and PROMs at 3 and 12 months postoperatively, including Numeric Rating Scale-Back/Leg and Oswestry Disability Index. Minimum clinically important difference of PROMs was set at 30% improvement from baseline.
Of 546 patients, 373 (68.3%) underwent TLIF and 173 underwent (31.7%) PLF. Median follow-up was 6.1 years (IQR = 3.6-9.0), with 339 (62.1%) >5-year follow-up. Multivariable logistic regression showed that patients undergoing TLIF had a lower odds of reoperation compared with PLF alone (odds ratio = 0.23, 95% CI = 0.54-0.99, P = .048). Among patients with >5-year follow-up, the same trend was seen (odds ratio = 0.15, 95% CI = 0.03-0.95, P = .045). No differences were observed in 90-day complications ( P = .487) and readmission rates ( P = .230) or minimum clinically important difference PROMs.
In a retrospective cohort study from a prospectively maintained registry, patients with grade 1 degenerative spondylolisthesis undergoing TLIF had significantly lower long-term reoperation rates than those undergoing PLF.
经椎间孔腰椎体间融合术（TLIF）和单纯经后路腰椎体间融合术（PLF）是治疗退行性腰椎滑脱症的两种手术方式。目前，尚不清楚哪种手术方式的效果更好。
比较退行性腰椎滑脱 1 度患者行 TLIF 与单纯 PLF 手术的长期再次手术率、并发症和患者报告的结局测量（PROMs）。
本研究采用回顾性队列研究设计，对 2010 年 10 月至 2021 年 5 月期间前瞻性收集的数据进行分析。纳入标准为年龄≥18 岁、退行性 1 度滑脱、行单节段、开放后路减压和内置物融合的择期手术患者，且随访时间≥1 年。主要暴露因素为 TLIF 与无椎间融合的 PLF。主要结局为再次手术。次要结局包括并发症、再入院、出院去向、重返工作岗位以及术后 3 个月和 12 个月的 PROMs，包括数字评分量表-腰背（Numeric Rating Scale-Back/Leg）和 Oswestry 残疾指数（Oswestry Disability Index）。PROMs 的最小临床重要差异设定为 30%基线改善。
546 例患者中，373 例（68.3%）行 TLIF，173 例（31.7%）行 PLF。中位随访时间为 6.1 年（IQR=3.6-9.0），其中 339 例（62.1%）随访时间>5 年。多变量逻辑回归显示，与单纯 PLF 相比，TLIF 患者再次手术的可能性较低（比值比=0.23，95%CI=0.54-0.99，P=0.048）。在随访时间>5 年的患者中，也观察到相同的趋势（比值比=0.15，95%CI=0.03-0.95，P=0.045）。90 天并发症（P=0.487）和再入院率（P=0.230）或最小临床重要差异 PROMs 方面无差异。
在一项来自前瞻性维护登记处的回顾性队列研究中，与单纯 PLF 相比，退行性腰椎滑脱 1 度患者行 TLIF 手术具有显著更低的长期再次手术率。
