Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China.
Department of the Hematology, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China.
BMC Musculoskelet Disord. 2024 Sep 4;25(1):708. doi: 10.1186/s12891-024-07815-1.
This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches.
From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion.
There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups.
There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise.
本研究回顾性比较了微创经椎间孔腰椎体间融合术（MIS-TLIF）和内镜下腰椎体间融合术（Endo-LIF）治疗两节段腰椎退行性疾病的短期临床疗效和并发症，旨在为脊柱外科医生选择手术方式提供指导。
自 2019 年 1 月至 2023 年 12 月，共纳入 30 例患者，其中 15 例采用 MIS-TLIF 治疗，15 例采用 Endo-LIF 治疗。所有患者术后均随访超过 3 个月，记录以下信息：（1）手术时间、术前与术后血红蛋白差值、手术费用、术后首次下床时间、术后住院时间、术后并发症；（2）ODI 评分（Oswestry 功能障碍指数）、腿部和背部 VAS 评分（视觉模拟评分）、腰椎 JOA 评分（日本骨科协会评分）；（3）末次随访时 MacNab 评分评估临床疗效，CT 评估腰椎融合情况。
两组在手术时间和费用方面存在显著差异，MIS-TLIF 组表现更好。Endo-LIF 组术中出血量明显少于 MIS-TLIF 组。然而，两组术后首次下床时间、术后住院时间和术后并发症无显著差异。两组手术前 VAS、ODI 和 JOA 评分无显著差异。两组在术后 1 天、7 天、1 个月、3 个月和末次随访时的 VAS（腿部）、ODI 和 JOA 评分均无显著差异。然而，术后 1 天，Endo-LIF 组的 VAS（背部）评分低于 MIS-TLIF 组，差异具有统计学意义。末次随访时，根据 Bridwell 标准，所有患者均达到 III 级及以上，两组间无显著差异。根据末次随访时的 MacNab 评分，Endo-LIF 组的优良率为 80.00%，MIS-TLIF 组为 73.33%，两组间无显著差异。
对于两节段退行性腰椎疾病，Endo-LIF 与 MIS-TLIF 的短期疗效和安全性无显著差异。MIS-TLIF 具有手术时间短、费用低的优点，而 Endo-LIF 造成的组织损伤、出血量和术后早期疼痛较小，有利于长期恢复。MIS-TLIF 和 Endo-LIF 均是治疗两节段腰椎退行性疾病的有前途的方法。手术方式的选择取决于患者的经济状况、对手术的耐受能力和外科医生的专业水平。
