侧转腰肌、前路和经椎间孔腰椎椎间融合术后急性疼痛和阿片类药物使用的比较分析

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-08-08 DOI:10.1016/j.xnsj.2025.100781

Ekrem M. Ayhan BS , Thomas Giannasca BS , Jake Laverdiere BS , Laura Sanzari MS , Gina Panek BS , Aris Yannopoulos MD

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引用次数: 0

摘要

背景：外侧经腰肌腰椎椎体间融合术与术后短暂的大腿前和腹股沟前感觉障碍和臀屈肌无力有关，这是由腰肌和腰丛的操作引起的。然而，尚不清楚这是否会导致更高的疼痛评分和阿片类药物需求。方法纳入2018年1月至2023年12月期间因退行性脊柱病理接受过一级或二级极端/直接（XLIF/DLIF）、前路（ALIF）或经椎间孔腰椎椎体间融合术（TLIF）的患者。所有病例进一步分类为独立或椎弓根螺钉固定，并将椎弓根螺钉固定作为协变量。结果采用多变量线性或二元logistic回归进行评估，包括住院时间（LOS）、住院患者每日最大疼痛评分、住院患者吗啡当量日剂量和总住院吗啡毫克当量、30天和90天并发症、急诊就诊、返回手术室和再入院，以及90天和1年的Oswestry残疾指数（ODI）和EuroQuol-5维度（EQ5D）。结果共纳入936例患者，其中XLIF/DLIFs 90例（9.6%），TLIFs 587例（62.7%），ALIFs 259例（27.6%）。不同入路间椎弓根螺钉固定差异显著（TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p<.001）。与ALIF和TLIF相比，XLIF/DLIF入路手术时间最短（p<.003）。此外，XLIF/DLIF方法的90天ODI低于TLIF （β= -21.185; p= 0.002）和ALIF (β= -9.275; p= 0.043)， 90天EQ5D高于TLIF （β=+27.389; p<.001）和ALIF (β=+13.897; p=.001)，吗啡当量日剂量高于TLIF （β=+29.115; p<.001）和ALIF (β=+11.959; p= 0.006)， LOS低于TLIF （β= -45.500小时；p= 0.014）和ALIF （β= -24.447小时；p= 0.049）。在最大疼痛评分、总住院吗啡毫克当量、并发症、再入院或返回手术室方面没有观察到显著差异。结论：与TLIF和ALIF相比，外侧经腰肌椎体间融合术手术时间较短，LOS较短，90天ODI和EQ5D较好，但术后住院阿片类药物消耗较高。证据水平ⅱ

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Comparative analysis of acute postoperative pain and opioid use between lateral transpsoas, anterior, and transforaminal lumbar interbody fusions

Background

The lateral transpsoas lumbar interbody fusion is associated with transient postoperative anterior thigh and inguinal dysesthesias and hip flexor weakness from manipulation of the psoas and interposed lumbar plexus. However, it remains unclear whether this translates to higher pain scores and opioid requirements.

Methods

Patients who had undergone one- or two-level extreme/direct (XLIF/DLIF), anterior (ALIF), or transforaminal lumbar interbody fusion (TLIF) between January 2018 and December 2023 for degenerative spinal pathology were included. All cases were further classified as standalone or pedicle screw-fixated, and pedicle screw-fixated was included as a covariate. Outcomes were assessed using multivariable linear or binary logistic regression and included length of stay (LOS), inpatient daily maximum pain scores, inpatient morphine-equivalent daily dosage, and total inpatient morphine milligram equivalents, 30- and 90-day complications, emergency department visits, return to operating room, and readmission, and 90-day and 1-year Oswestry Disability Index (ODI) and EuroQuol-5 Dimension (EQ5D).

Results

A total of 936 patients were assessed, including 90 (9.6%) XLIF/DLIFs, 587 (62.7%) TLIFs, and 259 (27.6%) ALIFs. Pedicle screw fixation differed significantly between approaches (TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p<.001). The XLIF/DLIF approach had the shortest operative time compared to ALIF and TLIF (p<.003). Furthermore, XLIF/DLIF approach was associated with lower 90-day ODI than TLIF (β=–21.185; p=.002) and ALIF (β=–9.275; p=.043), higher 90-day EQ5D than TLIF (β=+27.389; p<.001) and ALIF (β=+13.897; p=.001), higher morphine-equivalent daily dosage than TLIF (β=+29.115; p<.001) and ALIF (β=+11.959; p=.006), and shorter LOS than TLIF (β=–45.500 hours; p=.014) and ALIF (β=–24.447 hours; p=.049). No significant differences were observed in maximum pain scores, total inpatient morphine milligram equivalents, complications, readmissions, or return to operating room.

Conclusions

Despite a shorter operative time, shorter LOS, and better 90-day ODI and EQ5D, the lateral transpsoas lumbar interbody fusion is associated with higher postoperative inpatient opioid consumption than TLIF and ALIF.