Jadhakhan Feroz, Bell David, Rushton Alison
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
Neurosurgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
J Spine Surg. 2023 Mar 30;9(1):83-97. doi: 10.21037/jss-22-24. Epub 2023 Mar 1.
Debate regarding effectiveness of surgical modalities contributes to a lack of consensus of decision making for surgical interventions. Furthermore, data regarding cost effectiveness, surgical operative time, resources, patient hospital stay and recovery is limited, particularly in the medium term for degenerative lumbar spondylolisthesis. The objective was to compare clinical outcomes following different fixation interventions treating degenerative lumbar spondylolisthesis.
A retrospective cohort study using the British Spine Registry (BSR) of 1,838 patients aged ≥18 years. Five hundred and five patients undergoing posterior lumbar interbody fusion (PLIF) and 1,333 undergoing transforaminal lumbar interbody fusion (TLIF) with 6 months follow-up, were compared. Demographics, Oswestry Disability Index (ODI), Numerical Rating Scale (NRS) [back and leg], quality of life, complications and cost effectiveness were analysed.
NRS (back and leg) demonstrated a statistically significant difference favouring TLIF at 6 months (P=0.04) and (P<0.05) respectively. There was no difference in ODI improvement at 6 months between PLIF and TLIF (P=0.620), but there was a statistically significant difference in ODI scores preoperatively between PLIF and TLIF (P<0.001). EQ-5D-5L-Health VAS (P=0.136) and EQ-5D-5L (P=0.655) did not show a statistically significant difference in improvement between PLIF and TLIF. Dural tear was the most common complication and was higher in the PLIF group (5.7%) but not statistically significant. Estimated blood loss was greater for PLIF (P=0.041). Implant cost (P<0.001) was higher for TLIF whereas theatre time was higher for PLIF (P=0.031).
Both PLIF and TLIF result in clinically significant improvements in ODI, NRS back pain and NRS leg pain, with superiority of TLIF for improvements in back and leg pain. Surgeons appeared to use ODI preoperatively to decide intervention with comparable improvements for both approaches. Average theatre time and blood loss volume was higher for PLIF. Factors like implant costs and costs of consumables were higher for TLIF. Costs merit further evaluation.
关于手术方式有效性的争论导致在手术干预决策上缺乏共识。此外，关于成本效益、手术操作时间、资源、患者住院时间和恢复情况的数据有限，尤其是在退行性腰椎滑脱的中期。目的是比较不同固定干预治疗退行性腰椎滑脱后的临床结果。
一项回顾性队列研究，使用英国脊柱注册中心（BSR）中1838例年龄≥18岁的患者。比较了505例行后路腰椎椎间融合术（PLIF）和1333例行经椎间孔腰椎椎间融合术（TLIF）且随访6个月的患者。分析了人口统计学资料、奥斯威斯功能障碍指数（ODI）、数字评定量表（NRS）[背部和腿部]、生活质量、并发症和成本效益。
NRS（背部和腿部）在6个月时显示出有利于TLIF的统计学显著差异，分别为（P = 0.04）和（P < 0.05）。PLIF和TLIF在6个月时ODI改善情况无差异（P = 0.620），但PLIF和TLIF术前ODI评分存在统计学显著差异（P < 0.001）。EQ - 5D - 5L - 健康视觉模拟量表（P = 0.136）和EQ - 5D - 5L（P = 0.655）在PLIF和TLIF之间的改善情况未显示出统计学显著差异。硬脊膜撕裂是最常见的并发症，在PLIF组中更高（5.7%），但无统计学显著性。PLIF的估计失血量更大（P = 0.041）。TLIF的植入物成本更高（P < 0.001），而PLIF的手术时间更长（P = 0.031）。
PLIF和TLIF均可使ODI、NRS背痛和NRS腿痛在临床上得到显著改善，TLIF在改善背痛和腿痛方面更具优势。外科医生术前似乎使用ODI来决定干预方式，两种方法的改善效果相当。PLIF的平均手术时间和失血量更高。TLIF的植入物成本和耗材成本等因素更高。成本值得进一步评估。
