Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, Sichuan Province, China.
Sci Rep. 2024 Sep 27;14(1):22154. doi: 10.1038/s41598-024-73213-1.
Midline lumbar interbody fusion (MIDLIF) and minimally invasive transforaminal interbody fusion (MIS-TLIF) are two minimally invasive lumbar fusion methods that have gained popularity in the past two decades. MIDLIF involves the use of cortical bone trajectory screws, whereas MIS-TLIF uses traditional pedicle screws. However, there is a significant lack of research directly examining the clinical efficacy of these two methods in treating single-segment lumbar degenerative diseases. Hence, the objective of our retrospective study is to assess and contrast the surgical and clinical results of MIDLIF and MIS-TLIF. The study population comprised 133 patients diagnosed with single-segment lumbar degenerative disease that received treatment using either MIDLIF (n = 65) or MIS-TLIF (n = 68) in our department from January 2017 to January 2019. The fusion rates for MIDLIF were consistently lower than MID-TLIF at all post-operative time periods of follow-up, however, the differences between the two groups were not statistically significant. The 1-year fusion rates were 81.5% (MIDLIF) and 83.8% (MIS-TLIF) (P = 0.728), and the 2-year fusion rates were 87.7% (MIDLIF) and 91.2% (MIS-TLIF) (P = 0.513). The final follow-up fusion rates were 93.8% (MIDLIF) and 95.6% (MIS-TLIF) (P = 0.653). MIDLIF had several advantages over MIS-TLIF, including a shorter operative time (135.2 ± 15.70 vs. 160.1 ± 17.2 min, P < 0.001), decreased intraoperative blood loss (147.9 ± 36.4 vs. 169.5 ± 24.7 mL, P < 0.001), and a shorter length of hospital stay (10.8 ± 3.1 vs. 12.4 ± 4.1d; P = 0.014). No significant differences were seen between the groups in terms of the postoperative day of ambulation, Oswestry dysfunction index (ODI) scores, and visual analog scale (VAS) scores for leg and lower back pain (P > 0.05). Although not significant (P = 0.707), MIDLIF (13.8%) had fewer overall complications than MIS-TLIF (16.2%). Therefore, compared to MIS-TLIF, MIDLIF provides perioperative benefits while achieving the same outcomes as MIS-TLIF in terms of fusion rate, pain relief, functional improvement, and complication rate.
后路腰椎体间融合术（MIDLIF）和微创经椎间孔腰椎体间融合术（MIS-TLIF）是两种在过去二十年中得到广泛应用的微创腰椎融合方法。MIDLIF 采用皮质骨轨迹螺钉，而 MIS-TLIF 则使用传统的椎弓根螺钉。然而，目前直接研究这两种方法治疗单节段腰椎退行性疾病的临床疗效的研究还很少。因此，我们的回顾性研究旨在评估和比较 MIDLIF 和 MIS-TLIF 的手术和临床结果。研究人群包括 2017 年 1 月至 2019 年 1 月在我科接受治疗的 133 例单节段腰椎退行性疾病患者，其中 MIDLIF 组（n=65）和 MIS-TLIF 组（n=68）。在所有随访的术后时间段，MIDLIF 的融合率始终低于 MIS-TLIF，但两组之间的差异无统计学意义。1 年的融合率分别为 81.5%（MIDLIF）和 83.8%（MIS-TLIF）（P=0.728），2 年的融合率分别为 87.7%（MIDLIF）和 91.2%（MIS-TLIF）（P=0.513）。末次随访时的融合率分别为 93.8%（MIDLIF）和 95.6%（MIS-TLIF）（P=0.653）。MIDLIF 与 MIS-TLIF 相比具有几个优势，包括手术时间更短（135.2±15.70 分钟与 160.1±17.2 分钟，P<0.001），术中出血量更少（147.9±36.4 毫升与 169.5±24.7 毫升，P<0.001），以及住院时间更短（10.8±3.1 天与 12.4±4.1 天；P=0.014）。两组患者术后下床活动的时间、Oswestry 功能障碍指数（ODI）评分以及下肢和腰痛的视觉模拟评分（VAS）评分无显著差异（P>0.05）。尽管差异无统计学意义（P=0.707），但 MIDLIF（13.8%）的总体并发症发生率低于 MIS-TLIF（16.2%）。因此，与 MIS-TLIF 相比，MIDLIF 在手术时间、术中出血量、住院时间方面具有优势，同时在融合率、疼痛缓解、功能改善和并发症发生率方面与 MIS-TLIF 具有相同的效果。
