峡部裂性腰椎滑脱症行后路腰椎融合术加或不加椎间融合术：一项系统评价和荟萃分析

Posterior lumbar fusion with and without interbody fusion in isthmic spondylolisthesis: a systematic review and meta-analysis.

作者信息

Azizpour Kayoumars, Broekman Sverre J, Peul Wilco C, Vleggeert-Lankamp Carmen L A

机构信息

Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, 0031 71 5262109, The Netherlands.

Alrijne Hospital, Leiden & Leiderdorp, The Netherlands.

出版信息

Neurosurg Rev. 2025 Jul 28;48(1):581. doi: 10.1007/s10143-025-03703-x.

DOI:10.1007/s10143-025-03703-x

PMID:40717178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12301273/

Abstract

BACKGROUND

Isthmic spondylolisthesis is caused by a lesion in the pars articularis resulting in forward slippage of the vertebral segment relative to the caudal vertebral segment. Patients can develop neurogenic claudication or radiculopathy in case degeneration progresses. Nerve decompression is usually accompanied by spondylodesis: two frequently performed procedures are posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF).

METHODS

Studies from four databases (PubMed, Embase, Web of Science, COCHRANE Library and Emcare) were included that compared clinical outcomes of posterolateral fusion (PLF) versus posterior lumbar interbody fusion in patients with isthmic spondylolisthesis. For Oswestry Disability Index (ODI) pooled point estimate and the 95% confidence interval (CIs) was derived using the random-effects model.

RESULTS

Fourteen studies met the inclusion criteria of which four were randomized controlled trials (RCT), six were retrospective, and four were prospective cohort studies (two with historical control). The pooled results for ODI yielded no difference between PLF and PLIF with an estimated pooled mean difference of -0.29 (95% CI [-0.83, 0.26], = 0.45). A significant difference in favour of PLIF was demonstrated regarding SF-36 (1/3 studies) and VAS back pain (1/7 studies). None of the studies reporting Roland Disability Scores, Visual Analogue Scale (VAS) leg pain and (adjusted) Japanese Orthopedic Association score displayed a significant difference. Fusion rate was reported in favour of PLIF (2/6 studies).

CONCLUSIONS

Our results suggest that both PLF and PLIF are adequate options for the treatment of isthmic spondylolisthesis. However, included studies gave insufficient data on possible confounding factors like age, degeneration status, grade of slippage, disc height, smoking, and facet joint condition. Therefore, there is not enough evidence to support either PLF or PLIF as the best treatment option. Large multicentre RCTs with proper adjustment for confounding factors and clearly defined inclusion and exclusion criteria should determine whether the two treatment modalities are indeed comparable.

REGISTRATION

PROSPERO 2022 CRD42022338983.

CLINICAL TRIAL NUMBER

Not applicable.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10143-025-03703-x.

摘要

背景

峡部裂性腰椎滑脱是由关节突部病变引起的，导致椎体节段相对于尾侧椎体节段向前滑移。如果退变进展，患者可出现神经源性间歇性跛行或神经根病。神经减压通常伴有脊柱融合术：两种常用的手术是后外侧融合术（PLF）和后路腰椎椎间融合术（PLIF）。

方法

纳入来自四个数据库（PubMed、Embase、Web of Science、COCHRANE图书馆和Emcare）的研究，这些研究比较了峡部裂性腰椎滑脱患者后外侧融合术（PLF）与后路腰椎椎间融合术的临床结果。对于Oswestry功能障碍指数（ODI），采用随机效应模型得出合并点估计值和95%置信区间（CIs）。

结果

14项研究符合纳入标准，其中4项为随机对照试验（RCT），6项为回顾性研究，4项为前瞻性队列研究（2项有历史对照）。ODI的合并结果显示PLF和PLIF之间无差异，估计合并平均差异为-0.29（95%CI[-0.83, 0.26]，P = 0.45）。在SF-36（1/3项研究）和视觉模拟评分法（VAS）背痛方面（1/7项研究），显示PLIF有显著优势。报告罗兰功能障碍评分、视觉模拟评分法（VAS）腿痛和（调整后的）日本骨科协会评分的研究均未显示出显著差异。报告的融合率显示PLIF更优（2/6项研究）。

结论

我们的结果表明，PLF和PLIF都是治疗峡部裂性腰椎滑脱的合适选择。然而，纳入的研究在年龄、退变状态、滑移程度、椎间盘高度、吸烟和小关节状况等可能的混杂因素方面提供的数据不足。因此，没有足够的证据支持PLF或PLIF作为最佳治疗选择。需要进行大型多中心RCT，对混杂因素进行适当调整，并明确界定纳入和排除标准，以确定这两种治疗方式是否确实具有可比性。