Ryan S Beyer, Tara Shooshani, Bianca Batista, Genevieve M Fraipont, Omead Pooladzandi, Nolan J Brown, Zach Pennington, Martin H Pham
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引用次数: 0
Abstract
Study design: A meta-analysis approach to a systematic review.
Objective: Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes.
Summary of background data: Minimally invasive surgical techniques, particularly LLIF, have gained popularity for their potential to reduce muscle and soft tissue dissection, leading to faster postoperative recovery. LLIF has been associated with fewer complications compared with open posterior approaches. The introduction of expandable lumbar interbody devices aims to further reduce surgical difficulty and potential complications. However, concerns include a small graft window due to the expansion mechanism and higher costs.
Methods: The Web of Science, Scopus, and PubMed databases were systematically queried in accordance with PRISMA guidelines to identify articles comparing outcomes following LLIF using static and expandable interbodies. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias (ROB) in the selected studies. Extracted data underwent effect-size meta-analysis with the PyMARE library, using P<0.05 to define statistical significance.
Results: Of the 77 identified articles, 4 studies comprising 283 patients (mean age: 67.1 y, 55.8% female) met the inclusion and exclusion criteria. A total of 150 patients (53%) were treated with static interbodies compared with 133 (47%) receiving expandable interbodies. The groups did not differ significantly with respect to operative time (P=0.59), blood loss (P=0.89), length of stay (P=0.78), subsidence (P=0.49), 24-month mean disc height (P=0.11), 24-month mean ODI (P=0.58), or 24-month mean visual analog scale (VAS) back pain (P=0.81). The expandable group saw a trend toward improved fusion rates (97% vs. 92%, P=0.06).
Conclusions: The present meta-analysis suggests the use of expandable (vs. static) interbodies in LLIF surgery may result in similar surgical morbidity, subsidence, and decompression. Further prospective comparative studies are merited to validate these results.
研究设计：采用荟萃分析方法进行系统评价。目的：进行一项系统综述，以确定所有直接比较使用静态和可扩展椎体间固定器进行侧位腰椎椎体间融合（LLIF）结果的报告。特别关注围手术期并发症，术中发病率和融合结果。背景资料总结：微创手术技术，特别是LLIF，因其减少肌肉和软组织剥离的潜力而受到欢迎，从而更快地实现术后恢复。与后路开放入路相比，LLIF并发症较少。引入可伸缩腰椎椎体间装置旨在进一步降低手术难度和潜在并发症。然而，由于扩张机制和较高的成本，人们担心移植窗口较小。方法：根据PRISMA指南系统地查询Web of Science、Scopus和PubMed数据库，以识别使用静态和可扩展间体比较LLIF后结果的文章。采用纽卡斯尔-渥太华量表（NOS）评估入选研究的偏倚风险（ROB）。提取的数据使用PyMARE文库进行效应大小荟萃分析，结果：在77篇确定的文章中，4项研究包括283例患者（平均年龄：67.1岁，女性55.8%）符合纳入和排除标准。共有150名患者（53%）接受静态间体治疗，133名患者（47%）接受可扩展间体治疗。两组在手术时间（P=0.59）、出血量（P=0.89）、住院时间（P=0.78）、沉降（P=0.49）、24个月平均椎间盘高度（P=0.11）、24个月平均ODI （P=0.58）、24个月平均视觉模拟量表（VAS）背痛（P=0.81）方面均无显著差异。可伸缩组的融合率有提高的趋势（97%对92%，P=0.06）。结论：本荟萃分析表明，在LLIF手术中使用可伸缩（与静态）间体可能导致相似的手术发病率、下沉和减压。值得进一步的前瞻性比较研究来验证这些结果。
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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