微创经椎间孔腰椎椎体间融合术与单纯减压治疗1级腰椎滑脱的5年随访:结果有什么差异吗?

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Andrew K Chan, Vardhaan S Ambati, Pavan Upadhyayula, Dean Chou, Mohamad Bydon, Erica F Bisson, Steven D Glassman, Kevin T Foley, Christopher I Shaffrey, Eric A Potts, Chun-Po Yen, Domagoj Coric, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming Fu, Jonathan R Slotkin, Anthony L Asher, Michael S Virk, Regis W Haid, Praveen V Mummaneni
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引用次数: 0

摘要

目的:椎板切除术与固定椎弓根螺钉的试验报道了融合相比单纯椎板切除术治疗1级退行性腰椎滑脱患者的优势。然而,目前尚不清楚融合的优势是否可以扩展到微创手术(MIS)技术。这项研究比较了微创经椎间孔腰椎椎体间融合术(TLIF)和减压治疗1级腰椎滑脱后60个月的疗效。方法:作者从前瞻性质量结果数据库的12个最高入组点(SpineCORe团队)分析了接受单节段MIS TLIF或MIS管状减压治疗1级退行性腰椎滑脱的患者。单变量和多变量分析比较的结果包括Oswestry残疾指数(ODI)、背痛数值评定量表(NRS- bp)、腿痛数值评定量表(NRS- lp)、EuroQol-5D (EQ-5D)、北美脊柱协会(NASS)满意度评分和累计相关再手术率。结果:608例患者中,143例接受了MIS TLIF (n = 72, 50.3%)或MIS减压(n = 71, 49.7%)。整个研究队列的60个月随访率为86.8%。MIS TLIF组明显更年轻(平均62.1±10.6岁vs 72.3±9.7岁),糖尿病患病率更低(9.7% vs 22.5%),私人保险使用率更高(65.3% vs 26.8%),术前更有可能被雇佣(54.2% vs 23.9%),基线NRS-BP评分更高(平均6.9±2.6 vs 5.6±3.2,p < 0.05)。除此之外,这些队列的基线特征相似。术后60个月,两组患者ODI、NRS-LP、NRS-BP和EQ-5D评分均较各自基线有显著改善(p < 0.05)。MIS TLIF的再手术率明显低于前者(2.8% vs 15.5%, p = 0.008)。ODI、NRS-LP、NRS-BP和EQ-5D的最小临床重要差异率相等(p < 0.05)。MIS TLIF显著降低了NRS-BP评分(-4.0±3.5 vs -2.2±3.4)和更高的满意度(NASS评分1或2 = 87.7% vs 74.5%, p < 0.05),但60个月ODI、NRS-LP、NRS-BP和EQ-5D的绝对评分相似(p < 0.05)。在多变量分析中,融合显著降低了再手术的几率(OR 0.07, 95% CI 0.008-0.39; p = 0.006),但融合状态既不是ODI、NRS-LP、NRS-BP或EQ-5D评分的显著预测因子,也不是NASS满意度评分的显著预测因子。结论:无论采用何种手术入路,基于背侧的MIS技术与1级腰椎滑脱患者的临床获益相关。这些60个月的结果表明,MIS TLIF和MIS减压与患者报告的相似结果相关。然而,MIS TLIF的再手术次数明显减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Five-year follow-up after minimally invasive transforaminal lumbar interbody fusion versus decompression alone for grade 1 spondylolisthesis: are there any differences in outcomes?

Objective: The Spinal Laminectomy Versus Instrumented Pedicle Screw trial reported the superiority of fusion compared to laminectomy alone for patients with grade 1 degenerative spondylolisthesis. However, it remains unclear if the advantages of fusion extend to using minimally invasive surgical (MIS) techniques. This study compared 60-month outcomes following minimally invasive transforaminal lumbar interbody fusion (TLIF) versus decompression for grade 1 spondylolisthesis.

Methods: The authors analyzed patients who underwent single-segment MIS TLIF or MIS tubular decompression for grade 1 degenerative lumbar spondylolisthesis from the prospective Quality Outcomes Database's 12 highest enrolling sites (SpineCORe team). Uni- and multivariable analyses compared outcomes including the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EuroQol-5D (EQ-5D), North American Spine Society (NASS) satisfaction score, and cumulative related reoperation rate.

Results: Of 608 total patients, 143 underwent MIS TLIF (n = 72, 50.3%) or MIS decompression (n = 71, 49.7%). The overall study cohort's 60-month follow-up rate was 86.8%. The MIS TLIF cohort was significantly younger (mean 62.1 ± 10.6 vs 72.3 ± 9.7 years), had lower rates of diabetes (9.7% vs 22.5%), higher rates of private insurance utilization (65.3% vs 26.8%), was more likely to be employed preoperatively (54.2% vs 23.9%), and had higher baseline NRS-BP scores (mean 6.9 ± 2.6 vs 5.6 ± 3.2, p < 0.05). Otherwise, the cohorts were similar in baseline characteristics. Sixty months postoperatively, both cohorts had significant mean improvements in ODI, NRS-LP, NRS-BP, and EQ-5D scores compared to their respective baselines (p < 0.05). MIS TLIF had a significantly lower reoperation rate (2.8% vs 15.5%, p = 0.008). The minimal clinically important difference rates for the ODI, NRS-LP, NRS-BP, and EQ-5D were equivalent (p > 0.05). MIS TLIF demonstrated significantly larger reductions in NRS-BP scores (-4.0 ± 3.5 vs -2.2 ± 3.4) and higher rates of satisfaction (NASS score 1 or 2 = 87.7% vs 74.5%; p < 0.05) but similar absolute 60-month ODI, NRS-LP, NRS-BP, and EQ-5D scores (p > 0.05). On multivariable analyses, fusion significantly reduced the odds of reoperation (OR 0.07, 95% CI 0.008-0.39; p = 0.006), but fusion status was neither a significant predictor of ODI, NRS-LP, NRS-BP, or EQ-5D scores, nor NASS satisfaction scores.

Conclusions: Regardless of the surgical approach, a dorsal-based MIS technique was associated with clinical benefits in patients with grade 1 spondylolisthesis. These 60-month results demonstrate that MIS TLIF and MIS decompression are associated with similar patient-reported outcomes. However, MIS TLIF is associated with significantly fewer reoperations.

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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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