Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China.
J Orthop Surg Res. 2024 Feb 20;19(1):150. doi: 10.1186/s13018-024-04630-1.
Presently, no study has compared the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via the unilateral approach (BDUA) and Open-TLIF with bilateral decompression for degenerative lumbar diseases (DLD). We aimed to compare the clinical outcomes of through Mis-TLIF combined with BDUA and Open-TLIF with bilateral decompression for the treatment of DLD, and reported the learning curve of the procedure of MIS-TLIF with BDUA.
We retrospectively analyzed the prospectively collected data of consecutive DLD patients in the two groups from January 2016 to January 2020.
The operative time (OT) was significantly longer in the Mis-TLIF group (n = 113) than in the Open-TLIF group (n = 135). The postoperative drainage volume (PDV) and length of stay (LOS) were significantly higher in the Open-TLIF group than in the Mis-TLIF group. Additionally, the complication rate was significantly higher in the Open-TLIF group than in the Mis-TLIF group (14.8% vs. 6.2%, P = 0.030), while there was no significant difference in the reoperation and adjacent segment disease rates between the two groups. There were no significant differences in back pain and leg pain Numerical Rating Scale (NRS) scores and Oswestry Disability Index (ODI) between the two groups preoperatively, at discharge, and 2 years postoperatively. Patients in both groups showed significant improvements in NRS scores and ODI scores after surgery. OT was negatively correlated with the number of surgeries performed (P < 0.001, r = -0.43). The learning curve of Mis-TLIF with BDUA was steep, with OT tapered to steady state in 43 cases.
Compared with Open-TLIF with bilateral decompression, Mis-TLIF with BDUA can achieve equivalent clinical outcomes, lower PDV and LOS, and lower complication rates. Although this procedure took longer, it could be a viable alternative for the treatment of DLD after a steep learning curve.
目前，尚无研究比较经单侧入路双侧减压微创经椎间孔腰椎体间融合术（Mis-TLIF）与开放 TLIF 联合双侧减压治疗退行性腰椎疾病（DLD）的临床疗效。我们旨在比较经单侧入路双侧减压微创经椎间孔腰椎体间融合术（Mis-TLIF）与开放 TLIF 联合双侧减压治疗 DLD 的临床疗效，并报告经单侧入路双侧减压微创经椎间孔腰椎体间融合术（Mis-TLIF）的学习曲线。
我们回顾性分析了 2016 年 1 月至 2020 年 1 月连续两组 DLD 患者的前瞻性收集数据。
Mis-TLIF 组（n=113）的手术时间（OT）明显长于开放 TLIF 组（n=135）。开放 TLIF 组术后引流体积（PDV）和住院时间（LOS）明显高于 Mis-TLIF 组。此外，开放 TLIF 组的并发症发生率明显高于 Mis-TLIF 组（14.8% vs. 6.2%，P=0.030），但两组再手术率和相邻节段疾病率无显著差异。两组患者术前、出院时和术后 2 年的腰痛和腿痛数字评分量表（NRS）评分和 Oswestry 残疾指数（ODI）评分均无显著差异。两组患者术后 NRS 评分和 ODI 评分均有显著改善。OT 与手术次数呈负相关（P<0.001，r=-0.43）。Mis-TLIF 经单侧入路双侧减压的学习曲线陡峭，43 例 OT 达到稳定状态。
与开放 TLIF 联合双侧减压相比，Mis-TLIF 经单侧入路双侧减压可获得等效的临床疗效，降低 PDV 和 LOS，降低并发症发生率。虽然该手术时间较长，但在陡峭的学习曲线之后，可能是治疗 DLD 的一种可行替代方法。
