Shahzad Hania, Lee Maximillian, Epitropoulous Frank, Bhatti Nazihah, Singh Varun K, Kavuri Venkat, Yu Elizabeth
Department of Orthopaedics, Division of Spine Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
J Orthop. 2024 Jul 25;59:82-85. doi: 10.1016/j.jor.2024.07.010. eCollection 2025 Jan.
To describe utilization patterns of minimally invasive transforaminal lumbar interbody fusion (TLIF) procedures and to evaluate indirect healthcare utilization indicators such as revisions, infection, and complication rates for various TLIF techniques.
A retrospective analysis using the Pearldiver database was conducted to identify patients who underwent TLIF between 2010 and 2022. The patient population was stratified into four groups: TLIF with an open approach (TLIF-Open), TLIF with stereotactic navigation (TLIF-NAV), TLIF with the assistance of an operating microscope (TLIF-MI), and TLIF utilizing navigation and operating microscope (TLIF-Combined). Revision, infection, and complication rates were analyzed and compared between each technique with open procedure as the reference procedure using multivariate analysis.
Over the past 13 years, TLIF-Open procedures showed a consistent decrease in utilization, while TLIF-NAV, TLIF-MI, and TLIF-Combined approaches remained relatively stable without experiencing the same dramatic increase as the decline in TLIF-Open procedures. Multivariate regression analysis revealed, TLIF-NAV and TLIF-MI procedures were associated with a higher likelihood of undergoing revision surgeries within 30 days post-operatively, with TLIF-NAV also being linked to a higher risk of infection within 30 days. The TLIF-MI group had a lower likelihood of acute kidney injury (AKI), while the TLIF-NAV group had a lower likelihood of pneumonia and urinary tract infections (UTI).
There has been a noticeable shift in the utilization of TLIF procedures from open to minimally invasive approaches. While stereotactic navigation demonstrates favorable outcomes in terms of complications, surgeons must carefully consider infection risks and revision rates.
描述微创经椎间孔腰椎椎间融合术（TLIF）的使用模式，并评估各种TLIF技术的间接医疗利用指标，如翻修、感染和并发症发生率。
使用Pearldiver数据库进行回顾性分析，以确定2010年至2022年间接受TLIF手术的患者。患者群体分为四组：开放入路TLIF（TLIF-Open）、立体定向导航TLIF（TLIF-NAV）、手术显微镜辅助TLIF（TLIF-MI）以及使用导航和手术显微镜的TLIF（TLIF-Combined）。以开放手术作为参照手术，通过多变量分析对每种技术之间的翻修、感染和并发症发生率进行分析和比较。
在过去13年中，TLIF-Open手术的使用率持续下降，而TLIF-NAV、TLIF-MI和TLIF-Combined入路保持相对稳定，未出现与TLIF-Open手术下降相同的显著增长。多变量回归分析显示，TLIF-NAV和TLIF-MI手术在术后30天内进行翻修手术的可能性较高，TLIF-NAV在术后30天内感染风险也较高。TLIF-MI组发生急性肾损伤（AKI）的可能性较低，而TLIF-NAV组发生肺炎和尿路感染（UTI）的可能性较低。
TLIF手术的使用已从开放入路明显转向微创入路。虽然立体定向导航在并发症方面显示出良好的效果，但外科医生必须仔细考虑感染风险和翻修率。
