Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China.
BMC Musculoskelet Disord. 2023 Apr 10;24(1):274. doi: 10.1186/s12891-023-06374-1.
Currently, hidden blood loss (HBL) has been paid more and more attention by spine surgeons. Simultaneously, it has been the effort of spine surgeons to explore more advantages of minimally invasive surgery. More and more articles have compared unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). But so far, there is no HBL comparison between BE-LIF and MIS-TLIF. This study aims to compare the surgical invasiveness, hidden blood loss, and clinical outcome of BE-LIF and MIS-TLIF and to provide insight regarding minimally invasive surgery for lumbar degenerative disease (LDD).
We enrolled 103 eligible patients with LDD who underwent BE-LIF (n = 46) and MIS-TLIF (n = 57) during August 2020-March 2021. We collected data, including demographics, perioperative haematocrit, operative and postoperative hospital times, serum creatine kinase (CK) and C-reactive protein (CRP) levels, and hospitalization costs. Total and hidden blood loss was calculated. Clinical outcomes were assessed using a visual analogue scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications.
Basic demographics and surgical data were comparable. The CRP and CK levels were generally lower in the BE-LIF than in the MIS-TLIF group, especially CRP levels on postoperative day (POD) three and CK levels on POD one. True total blood loss, postoperative blood loss, and hidden blood loss were significantly reduced in the BE-LIF group compared with the MIS-TLIF group. Postoperative hospital times was statistically significantly shorter in the BE-LIF group. The VAS pain and ODI scores improved in both groups. At three days and one month, the VAS lower back pain scores were significantly better after BE-LIF. Clinical outcomes did not otherwise differ between groups.
Compared with MIS-TLIF, BE-LIF has similar medium and short-term clinical outcomes. However, it is better regarding surgical trauma, early lower back pain, total and hidden blood loss, and recovery time. BE-LIF is an adequate option for selected LDD.
目前，脊柱外科医生越来越关注隐性失血（HBL）。同时，探索微创手术的更多优势也是脊柱外科医生的努力方向。越来越多的文章比较了单侧双通道内镜下腰椎间融合术（BE-LIF）和微创经椎间孔腰椎间融合术（MIS-TLIF）。但到目前为止，还没有 BE-LIF 和 MIS-TLIF 之间的 HBL 比较。本研究旨在比较 BE-LIF 和 MIS-TLIF 的手术侵袭性、隐性失血和临床结果，并为腰椎退行性疾病（LDD）的微创手术提供见解。
我们纳入了 2020 年 8 月至 2021 年 3 月期间接受 BE-LIF（n=46）和 MIS-TLIF（n=57）治疗的 103 例 LDD 患者。我们收集了包括人口统计学、围手术期血细胞比容、手术和术后住院时间、血清肌酸激酶（CK）和 C 反应蛋白（CRP）水平以及住院费用在内的数据。计算总失血量和隐性失血量。使用视觉模拟评分（VAS）评分评估背部和腿部疼痛、Oswestry 残疾指数（ODI）、改良 MacNab 标准、融合率和并发症评估临床结果。
基本人口统计学和手术数据具有可比性。BE-LIF 组的 CRP 和 CK 水平普遍低于 MIS-TLIF 组，尤其是 CRP 水平在术后第 3 天和 CK 水平在术后第 1 天。与 MIS-TLIF 组相比，BE-LIF 组的真总失血量、术后失血量和隐性失血量显著减少。BE-LIF 组术后住院时间明显缩短。两组 VAS 疼痛和 ODI 评分均有所改善。在第 3 天和第 1 个月时，BE-LIF 后的下腰痛 VAS 评分明显更好。两组之间的临床结果没有其他差异。
与 MIS-TLIF 相比，BE-LIF 具有相似的中短期临床结果。然而，它在手术创伤、早期腰痛、总失血量和隐性失血量以及恢复时间方面具有优势。BE-LIF 是一种治疗选择腰椎退行性疾病的合适选择。
