Lang Z, Yuan Q, He D, Sun Y Q
Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2024 Mar 19;104(11):870-876. doi: 10.3760/cma.j.cn112137-20230913-00456.
To conduct a comparative study of radiological and clinical outcomes between percutaneous transfacet screw (TFS) and pedicle screw (BPS) in oblique lateral lumbar interbody fusion (OLIF) for single-level lumbar spinal stenosis. A retrospective cohort study. Patients who underwent OLIF with TFS or BPS for the treatment of single-level lumbar spinal stenosis at Beijing Jishuitan Hospital from January 2019 to June 2022 were retrospectively analyzed. Radiological parameters and clinical indicators were compared between the two groups. Radiological parameters included preoperative, immediate postoperative (within 5 days), and 1-year postoperative measurements of disc height and segmental lordosis angle, as well as interbody fusion status at 1 year postoperatively. Clinical indicators included operative time, blood loss, length of hospital stay, complications, and Oswestry Disability Index (ODI), visual analogue scale (VAS) scores for back pain, and leg pain before and 1 year after surgery. Four male and 10 female patients with an average age of (61.0±11.2) years underwent OLIF with TFS, while 9 male and 12 female patients underwent OLIF with BPS, with a mean age of (60.9±6.7) years. There was no statistically significant difference in preoperative disc height between the TFS and BPS groups (>0.05). The immediate postoperative disc height was (12.9±2.1) mm and it was (10.4±1.7) mm at 1-year follow-up in the TFS group; in the BPS group, it was (12.9±2.1) mm immediately postoperatively and (11.9±2.1) mm at 1-year follow-up; there was statistically significant difference between the two groups at 1-year follow-up (=0.037). The segmental lordosis angle showed no significant differences within each group or between the two groups at preoperative, immediate postoperative, or 1-year postoperative follow-up (all >0.05). At 1-year postoperative follow-up, the fusion rates was 92.9%(13/14) in the TFS group and 95.2%(20/21) in the BPS group, with no statistically significant difference between the two groups (>0.05). The TFS group had a significantly shorter operative time and less blood loss compared to the BPS group [(164.3±33.9) minutes vs (191.7±31.8) minutes and (74.3±46.9) ml vs (124.8±54.0) ml, respectively] (both <0.05). Both groups showed significant improvement in ODI and VAS scores at 1 year postoperatively compared to those preoperatively, but with no statistically significant difference was found between the groups (both >0.05). OLIF with TFS fixation can effectively restore disc height and alleviate back and leg pain in patients with single-level lumbar spinal stenosis. Compared to the OLIF with BPS procedure, OLIF with TFS has shorter operative time and less blood loss.
进行经皮经关节突螺钉（TFS）与椎弓根螺钉（BPS）在单节段腰椎管狭窄症斜外侧腰椎椎间融合术（OLIF）中放射学和临床结果的比较研究。一项回顾性队列研究。对2019年1月至2022年6月在北京积水潭医院接受TFS或BPS OLIF治疗单节段腰椎管狭窄症的患者进行回顾性分析。比较两组的放射学参数和临床指标。放射学参数包括术前、术后即刻（5天内）和术后1年的椎间盘高度和节段性前凸角测量值，以及术后1年的椎间融合状态。临床指标包括手术时间、失血量、住院时间、并发症以及Oswestry功能障碍指数（ODI）、术前和术后1年的背痛和腿痛视觉模拟量表（VAS）评分。14例患者接受TFS OLIF，其中男性4例，女性10例，平均年龄（61.0±11.2）岁；21例患者接受BPS OLIF，其中男性9例，女性12例，平均年龄（60.9±6.7）岁。TFS组和BPS组术前椎间盘高度无统计学显著差异（>0.05）。TFS组术后即刻椎间盘高度为（12.9±2.1）mm，1年随访时为（10.4±1.7）mm；BPS组术后即刻为（12.9±2.1）mm，1年随访时为（11.9±2.1）mm；两组在1年随访时有统计学显著差异（=0.037）。节段性前凸角在术前、术后即刻或术后1年随访时，每组内及两组间均无显著差异（均>0.05）。术后1年随访时，TFS组融合率为92.9%（13/14），BPS组为95.2%（20/21），两组间无统计学显著差异（>0.05）。与BPS组相比，TFS组手术时间明显更短，失血量更少[分别为（164.3±33.9）分钟对（191.7±31.8）分钟和（74.3±46.9）ml对（124.8±54.0）ml]（均<0.05）。两组术后1年的ODI和VAS评分与术前相比均有显著改善，但组间无统计学显著差异（均>0.05）。TFS固定的OLIF可有效恢复单节段腰椎管狭窄症患者的椎间盘高度，减轻背痛和腿痛。与BPS OLIF手术相比，TFS OLIF手术时间更短，失血量更少。
