Hu Xijian, Yan Lei, Chai Jing, Zhao Xiaofeng, Liu Haifeng, Zhu Jinhuai, Chai Huo, Zhao Yibo, Zhao Bin
Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Orthop Surg. 2025 May;17(5):1287-1297. doi: 10.1111/os.14371. Epub 2025 Feb 3.
Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).
A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.
Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.
Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.
尽管近年来内镜技术在腰椎融合手术中的应用越来越多，但与外侧融合相比，内镜下后外侧融合的优缺点仍不明确。比较六种不同的单节段腰椎椎间融合手术，以确定间接减压融合在治疗腰椎退行性疾病（LDD）时能否达到与微创直接减压融合相当的疗效和安全性水平。
在PubMed、Embase和Cochrane图书馆数据库中进行文献检索，检索2004年至2024年3月发表的关于LDD治疗的研究。从研究中提取预设临床结局指标的数据，包括手术时间、术中估计失血量（EBL）、住院时间（LOS）、并发症、视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）。
本综述纳入了35项研究，共3467例患者。网状Meta分析显示，各手术方法在疼痛和功能障碍改善或不良事件方面无显著差异，但单通道内镜下腰椎椎间融合术（UELIF）导致的ODI改善程度低于斜外侧椎间融合术（OLIF）。独立外侧腰椎椎间融合术（SA-LLIF）在手术时间和LOS等早期疗效指标方面表现最佳。OLIF和SA-LLIF的融合率高于UELIF和微创经椎间孔腰椎椎间融合术（MIS-TLIF）。MIS-TLIF导致的EBL比OLIF、SA-LLIF和UELIF更多。
无论采用间接减压还是直接减压，微创腰椎椎间融合术在LDD患者中均取得了良好的治疗效果，而SA-LLIF具有更好的早期疗效。
