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Title: [Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients].
Author: Yang Z, Liu B, Lan H, Ye H, Chen J, Xia H, Zhang Y, Han F.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 May 15; 34(5):550-556. PubMed ID: 32410419.
Abstract:
OBJECTIVE: To compare the effectiveness of modified transforaminal lumbar interbody fusion (modified-TLIF) and posterior lumbar interbody fusion (PLIF) for mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. METHODS: The clinical data of 106 patients with mild to moderate lumbar spondylolisthesis (Meyerding classification≤Ⅱ degree) who met the selection criteria between January 2015 and January 2017 were retrospectively analysed. All patients were divided into modified-TLIF group (54 cases) and PLIF group (52 cases) according to the different surgical methods. There was no significant difference in preoperative clinical data of gender, age, disease duration, sliding vertebra, Meyerding grade, and slippage type between the two groups ( P>0.05). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, hospital stay, and complications of the two groups were recorded and compared. The improvement of pain and function were evaluated by the visual analogue scale (VAS) score and Japanese Orthopedic Association (JOA) score at preoperation, 1 week, and 1, 6, 12 months after operation, and last follow-up, respectively. The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up, and the effectiveness of fusion was evaluated according to Suk criteria. RESULTS: All patients were followed up, the modified-TLIF group was followed up 25-36 months (mean, 32.7 months), the PLIF group was followed up 24-38 months (mean, 33.3 months). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group ( P<0.05). The VAS score and JOA score of both groups were significantly improved at each time point after operation ( P<0.05); the scores of the modified-TLIF group were significantly better than those of the PLIF group at 1 and 6 months after operation ( P<0.05). The slip angle and intervertebral altitude of both groups were obviously improved at last follow-up ( P<0.05), and there was no significant difference between the two groups at preoperation and last follow-up ( P>0.05). At last follow-up, the fusion rate of the modified-TLIF group and the PLIF group was 96.3% (52/54) and 98.1% (51/52), respectively, and no significant difference was found between the two groups ( χ ²=0.000, P=1.000). About complications, there was no significant difference between the two groups in nerve injury on the opposite side within a week, incision infection, and pulmonary infection ( P>0.05). No case of nerve injury on the operation side within a week or dural laceration occurred in the modified-TLIF group, while 8 cases (15.4%, P=0.002) and 4 cases (7.7%, P=0.054) occurred in the PLIF group respectively. CONCLUSION: Modified-TLIF and PLIF are effective in the treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. However, modified-TLIF has relatively less trauma, lower blood loss, lower drainage volume, lower incidence of dural laceration and nerve injury, which promotes enhanced recovery after surgery. 目的: 比较改良经椎间孔入路腰椎椎间融合术（transforaminal lumbar interbody fusion，TLIF）与后路腰椎椎间融合术（posterior lumbar interbody fusion，PLIF）治疗中老年轻中度腰椎滑脱症的手术疗效。. 方法: 回顾分析 2015 年 1 月—2017 年 1 月收治的符合选择标准的 106 例轻中度腰椎滑脱症（Meyerding 分度≤Ⅱ度）患者临床资料，根据手术方式不同分为改良 TLIF 组（54 例）及 PLIF 组（52 例）。两组患者性别、年龄、病程、滑脱椎体、Meyerding 分度及滑脱类型等一般资料比较，差异均无统计学意义（ P>0.05）。记录并比较两组术中出血量、手术时间、术后引流量、术后卧床时间、住院时间、并发症等围术期相关指标。术前及术后 1 周，1、6、12 个月，末次随访时采用疼痛视觉模拟评分（VAS）和日本骨科协会（JOA）评分评价疼痛及功能改善情况，术前与末次随访时测量滑脱角与椎间隙高度评价椎体滑脱矫正情况，末次随访时根据 Suk 标准判定椎间融合情况。. 结果: 所有患者均获随访，随访时间 A 组 25～36 个月，平均 32.7 个月；B 组 24～38 个月，平均 33.3 个月。改良 TLIF 组术中出血量、手术时间、术后引流量、术后卧床时间和住院时间均显著少于 PLIF 组（ P<0.05）。两组患者术后各时间点 VAS 评分和 JOA 评分均较术前显著改善（ P<0.05）；术后 1、6 个月改良 TLIF 组 VAS 评分和 JOA 评分显著优于 PLIF 组（ P<0.05）。两组患者末次随访时滑脱角及椎间隙高度均较术前显著改善（ P<0.05）；术前及末次随访时两组间滑脱角及椎间隙高度比较差异均无统计学意义（ P>0.05）。末次随访时根据 Suk 标准，改良 TLIF 组椎间融合率为 96.3%（52/54），PLIF 组为 98.1%（51/52），两组比较差异无统计学意义（ χ ²=0.000， P=1.000）。并发症：两组患者切口感染、肺部感染及术后 1 周内健侧神经损伤发生率比较差异均无统计学意义（ P>0.05）；改良 TLIF 组均未发生术中硬脊膜损伤及术后 1 周内患侧神经损伤，PLIF 组分别发生 4 例（7.7%， P=0.054）和 8 例（15.4%， P=0.002）。. 结论: 改良 TLIF 与 PLIF 手术治疗中老年轻中度腰椎滑脱症疗效肯定，改良 TLIF 手术对脊柱后柱正常结构损伤小、出血量和引流量少，硬脊膜和神经损伤发生率低，可改善术后疼痛，促进患者术后快速康复。.

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