Department of Spine Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China.
Department of Orthopedic, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
BMC Musculoskelet Disord. 2024 Feb 3;25(1):108. doi: 10.1186/s12891-024-07214-6.
Both instrumented and stand-alone lateral lumbar interbody fusion (LLIF) have been widely used to treat lumbar degenerative disease. However, it remains controversial as whether posterior internal fixation is required when LLIF is performed. This meta-analysis aims to compare the radiographic and clinical results between instrumented and stand-alone LLIF.
PubMed, EMBASE and Cochrane Collaboration Library up to March 2023 were searched for studies that compared instrumented and stand-alone LLIF in the treatment of lumbar degenerative disease. The following outcomes were extracted for comparison: interbody fusion rate, cage subsidence rate, reoperation rate, restoration of disc height, segmental lordosis, lumbar lordosis, visual analog scale (VAS) scores of low-back and leg pain and Oswestry Disability Index (ODI) scores.
13 studies involving 1063 patients were included. The pooled results showed that instrumented LLIF had higher fusion rate (OR 2.09; 95% CI 1.16-3.75; P = 0.01), lower cage subsidence (OR 0.50; 95% CI 0.37-0.68; P < 0.001) and reoperation rate (OR 0.28; 95% CI 0.10-0.79; P = 0.02), and more restoration of disc height (MD 0.85; 95% CI 0.18-1.53; P = 0.01) than stand-alone LLIF. The ODI and VAS scores were similar between instrumented and stand-alone LLIF at the last follow-up.
Based on this meta-analysis, instrumented LLIF is associated with higher rate of fusion, lower rate of cage subsidence and reoperation, and more restoration of disc height than stand-alone LLIF. For patients with high risk factors of cage subsidence, instrumented LLIF should be applied to reduce postoperative complications.
经器械辅助的和单纯的侧方腰椎间融合术（LLIF）已广泛应用于治疗腰椎退行性疾病。然而，当行 LLIF 时是否需要后路内固定仍存在争议。本 meta 分析旨在比较经器械辅助的和单纯的 LLIF 的影像学和临床结果。
检索 PubMed、EMBASE 和 Cochrane 协作图书馆截至 2023 年 3 月的研究，比较经器械辅助的和单纯的 LLIF 治疗腰椎退行性疾病的疗效。提取以下结果进行比较：椎间融合率、cage 沉降率、再次手术率、椎间盘高度恢复、节段前凸角、腰椎前凸角、腰背和腿痛视觉模拟评分（VAS）以及 Oswestry 功能障碍指数（ODI）评分。
纳入 13 项研究，共 1063 例患者。汇总结果显示，经器械辅助的 LLIF 融合率更高（OR 2.09；95%CI 1.16-3.75；P=0.01），cage 沉降率和再次手术率更低（OR 0.50；95%CI 0.37-0.68；P<0.001；OR 0.28；95%CI 0.10-0.79；P=0.02），椎间盘高度恢复更多（MD 0.85；95%CI 0.18-1.53；P=0.01）。末次随访时，经器械辅助的和单纯的 LLIF 的 ODI 和 VAS 评分相似。
基于这项 meta 分析，与单纯的 LLIF 相比，经器械辅助的 LLIF 融合率更高，cage 沉降和再次手术率更低，椎间盘高度恢复更多。对于 cage 沉降高危患者，应应用经器械辅助的 LLIF 以减少术后并发症。
