42. 开放性小切口TLIF （4.0 cm）与混合型内镜下TLIF的比较研究手术及早期临床结果报告

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100736

Thippatai Chaichompoo MD , Woraphot Wichan MD

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引用次数: 0

摘要

背景背景目前，微创脊柱手术因其良好的手术效果和患者快速恢复正常活动的能力而受到外科医生的青睐。许多来自不同机构的外科医生表示，与微创或开放式TLIF手术相比，单门静脉入路和双门静脉入路进行内窥镜TLIF手术同样有效。TLIF内窥镜手术需要先进的外科技术和专门的内窥镜设备，与典型的开放TLIF手术相比，这包括昂贵的材料，只有4.0厘米的小切口。哪种手术更好？目的本研究对开放小切口TLIF （4.0 cm）与混合内镜TLIF进行了比较研究。研究设计/设置：回顾性研究。在2023年2月1日至2023年9月30日期间，共63例患者接受了单节段开放式TLIF和混合内窥镜TLIF手术。术后第一天、出院当天和术后3个月的腿部（疼痛）和背部（疼痛）视觉模拟量表（VAS）。术前和术后3个月的ODI数据，以及患者满意度评估。手术数据，包括手术时间、出血量、并发症、止痛药和术后住院等信息。方法：这是一项回顾性研究，包括63例在2023年2月1日至2023年9月30日期间接受了单节段开放式TLIF和混合内窥镜TLIF手术的患者。根据采用的手术技术将患者分为两组：开放TLIF组（n = 34）和混合内镜TLIF组（n = 29）。该研究选择了有症状和不稳定腰椎滑脱的个体，而排除了那些诊断为癌症或感染的个体。通过收集一般数据，包括性别、年龄、基础疾病、身体质量指数（BMI）、吸烟状况等，收集患者术后第一天、出院当天和术后3个月的术前、术后症状，如腿部VAS（疼痛）和背部VAS（疼痛）。收集术前和术后3个月ODI数据，并评估患者满意度。在手术过程中收集数据，包括手术持续时间、出血量、并发症、止痛药和术后住院等信息。结果共纳入63例患者。两组患者在平均年龄、性别、BMI、术中出血量、止痛药使用、住院时间等方面均无统计学差异(P >；0.05)。然而，与混合内镜TLIF组相比，开放TLIF组的平均手术时间明显缩短（p < 0.05）。术后第1天，开放式TLIF组腰痛VAS评分明显低于混合内镜TLIF组（p0.05）。两组ODI评分均有改善，两组间无明显差异。(p> 0.05)。开放式TLIF组满意率为91.8%，混合内镜TLIF组满意率为87.6%。两组间无显著差异。(P> 0.05)。混合内镜TLIF组术后出现3例神经失用，均在3周内消失。另外，1例患者需要翻修椎弓根螺钉。开放TLIF组出现4例神经失用，均在4周内完全恢复。结论混合式内镜下TLIF手术在减少术后第一天、出院当天、术后3个月的腿部和背部疼痛、改善术前、术后3个月的生活质量、改善出血量、术后住院和止痛药使用等方面均不优于开放式TLIF手术。然而，与开放式TLIF手术相比，混合内镜TLIF手术需要更长的手术时间和更多的透视辐射暴露，并且需要更昂贵的材料。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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42. Comparative study between open mini-incision TLIF (4.0 cm) vs hybrid endoscopic TLIF; surgical and early clinical results report

BACKGROUND CONTEXT

Currently, minimally invasive spine surgery is favored by surgeons because of its favorable surgical outcomes and the ability for patients to quickly resume their normal activities. Many surgeons from different institutions have stated that both uniportal and biportal approaches for endoscopic TLIF surgery are equally effective compared to micro TLIF or open TLIF surgery. TLIF endoscopic surgery necessitates advanced surgical expertise and specialized endoscopic equipment, which includes costly materials in comparison to typical open TLIF surgery with a mini-incision of 4.0 cm. Which procedure is superior?

PURPOSE

This study has conducted a comparative study between open mini-incision TLIF (4.0 cm) versus hybrid endoscopic TLIF.

STUDY DESIGN/SETTING

Retrospective study.

PATIENT SAMPLE

A total of 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023.

OUTCOME MEASURES

Visual analog scale (VAS) leg (pain) and back (pain), on the first day after surgery, the day of discharge, and 3 months after. ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Surgical data, including information on the duration of surgery surgery, blood loss, complications, pain medication, and postoperative hospitalization.

METHODS

This is a retrospective study that included 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023. The patients were categorized into two groups based on the surgical techniques used: the open TLIF group (n = 34) and the hybrid endoscopic TLIF group (n = 29). The study selected individuals with symptomatic and unstable spondylolisthesis of the lumbar spine while excluding those diagnosed with cancer or infection. By collecting general data, including gender, age, underlying disease, body mass index (BMI), and smoking status, we will collect information on symptoms before and after surgery, such as leg VAS (pain) and back VAS (pain), on the first day after surgery, the day of discharge, and 3 months after. Collection of ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Data was collected during the surgery, including information on the duration of surgery, blood loss, complications, pain medication, and postoperative hospitalization.

RESULTS

A total of 63 patients were enrolled. There were no statistically significant differences in mean ages, genders, BMI, intraoperative blood loss, painkiller usage, or length of hospital stay between the two groups (P > 0.05). Nevertheless, the mean operative time was significantly less in the open TLIF group compared to the hybrid endoscopic TLIF group (p 0.05). The VAS for back pain was significantly lower in the open TLIF group compared to the hybrid endoscopic TLIF group on the first day after surgery (p0.05). Regarding the ODI scores, there was improvement observed in both groups, and no significant difference was found between the two groups. (p>0.05). The open TLIF group had a satisfaction rating of 91.8%, whereas the hybrid endoscopic TLIF group had a satisfaction rate of 87.6%. There was no significant difference between the two groups. (P>0.05). The hybrid endoscopic TLIF group experienced 3 cases of postoperative neurapraxia, all of which resolved within 3 weeks. Additionally, one patient required the revision of pedicular screws. Four occurrences of neurapraxia were identified in the open TLIF group, with complete recovery occurring within 4 weeks.

CONCLUSIONS

Hybrid endoscopic TLIF surgery is not superior to open TLIF surgery in terms of reducing the leg and back pain on the first day after surgery, the day of discharge, and 3 months after surgery in addition to improving quality of life before and 3 months after surgery, blood loss, postoperative hospitalization and painkillers usage. Nevertheless, hybrid endoscopic TLIF surgery takes significantly longer operative time and more fluoroscopic radiation exposure than open TLIF surgery and requires more costly materials.