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  • Title: [Short-term effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion for Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis].
    Author: Shu P, Wang Z, Chen G.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Oct 15; 36(10):1207-1212. PubMed ID: 36310456.
    Abstract:
    OBJECTIVE: To investigate the short-term effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. METHODS: The clinical data of 26 patients with Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis treated with UBE-TLIF between January 2021 and August 2021 were retrospectively analyzed. Among them, there were 10 males and 16 females with a mean age of 61.5 years (range, 35-76 years). The lesion segment included L 3, 4 in 2 cases, L 4, 5 in 18 cases, and L 5, S 1 in 6 cases. There were 17 cases of degenerative spondylolisthesis and 9 cases of isthmic spondylolisthesis; according to the Meyerding classification of spondylolisthesis, 19 cases were grade Ⅰ and 7 cases were grade Ⅱ. Twenty-one cases were complicated with lumbar disc herniation and spinal stenosis and 5 cases with lumbar spinal stenosis. The operation time, hospitalization stay, complications, hemoglobin (Hb) and serum creatine kinase (CK) levels before operation and at 1 day after operation were recorded; lumbar lordosis angle changes and postoperative spondylolisthesis reduction were evaluated by lumbar anteroposterior and lateral X-ray films before operation and at last follow-up; visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain before operation, at 2 days, 1 week, 2 weeks after operation, and at last follow-up; Oswestry disability index (ODI) was used to evaluate the functional recovery of the patients before operation and at last follow-up. RESULTS: The operation was successfully completed in all 26 patients, with an average operation time of 181.9 minutes (range, 130-224 minutes) and an average hospitalization stay of 6.3 days (range, 3-9 days). Hb levels were significantly lower and serum CK levels were significantly higher at 1 day after operation when compared with those before operation ( t=7.594, P<0.001; t=-15.647, P<0.001). No serious complication occurred during and after operation. CT examination at 3 days after operation showed that the percutaneous screw was not in good position in 1 case, and nerve paralysis (pain, numbness) occurred in 2 cases after operation, which were improved within 2 weeks after operation. All the 26 patients were followed up 6-11 months, with an average of 8.7 months. Complete reduction (the slippage reduction rate was 100%) was achieved in 24 patients (92.3%), and partial reduction (the slippage reduction rate was 87.5%) in 2 patients (7.7%). During the follow-up, there was no complication such as incision infection, fusion Cage subsidence or displacement, and internal fixator loosening. The VAS scores of low back pain and leg pain significantly improved at each time point after operation when compared with those before operation ( P<0.05); there was no significant difference in the VAS scores of low back pain and leg pain between at 2 days and 1 week after operation, the VAS scores of low back pain between at 1 week and 2 weeks after operation, and the VAS scores of leg pain between at 2 weeks after operation and last follow-up ( P>0.05); but there was significant difference between the other time points after operation ( P<0.05). ODI and lumbar lordosis angle significantly improved at last follow-up ( P<0.05). CONCLUSION: UBE-TLIF provides favorable short-term effectiveness and obvious advantages of minimally invasive in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. However, the safety and long-term effectiveness need to be further studied. 目的: 评价单侧双通道脊柱内镜下经椎间孔腰椎椎体间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）治疗单节段MeyerdingⅠ、Ⅱ度腰椎滑脱症的近期疗效。. 方法: 回顾性分析2021年1月—8月应用UBE-TLIF治疗的26例单节段MeyerdingⅠ、Ⅱ度腰椎滑脱症患者临床资料。其中男10例，女16例；年龄35～76岁，平均61.5岁。病变节段：L 3、4 2例，L 4、5 18例，L 5、S 1 6例。其中退行性滑脱17例，峡部裂性滑脱9例；根据Meyerding滑脱分度：Ⅰ度19例，Ⅱ度7例。合并腰椎间盘突出伴椎管狭窄21例，腰椎管狭窄5例。记录患者手术时间、住院时间及并发症发生情况；术前、术后1 d血红蛋白（hemoglobin，Hb）和血清肌酸激酶（creatine kinase，CK）水平；术前和末次随访时摄腰椎正侧位X线片评估腰椎前凸角变化及术后滑脱复位情况；术前，术后2 d、1周、2周及末次随访时采用疼痛视觉模拟评分（VAS）评估患者腰背痛和腿痛情况；术前及末次随访时采用Oswestry功能障碍指数（ODI）评估患者功能恢复情况。. 结果: 26例患者均顺利完成手术，手术时间130～224 min，平均181.9 min；住院时间3～9 d，平均6.3 d。术后1 d Hb水平较术前下降，血清CK水平较术前增高，差异均有统计学意义（ t=7.594， P<0.001； t=–15.647， P<0.001）。术中和术后无严重并发症发生，1例术后3 d CT检查发现经皮螺钉位置不佳，2例术后出现神经麻痹症状（疼痛、麻木），均于术后2周内改善。26例患者均获随访，随访时间6～11个月，平均8.7个月。24例（92.3%）患者滑脱完全复位（滑脱复位率100%），2例（7.7%）部分复位（滑脱复位率87.5%）。患者随访期间均未发生手术切口感染、融合器下沉或移位以及内固定物松动等并发症。术后各时间点腰背痛及腿痛VAS评分均较术前显著改善（ P<0.05）；术后1周腰背痛及腿痛VAS评分与术后2 d 比较、术后2周腰背痛VAS评分与术后1周比较，以及末次随访时腿痛VAS评分与术后2周比较，差异均无统计学意义（ P>0.05），余术后各时间点间比较差异均有统计学意义（ P<0.05）。末次随访时ODI及腰椎前凸角均较术前显著改善（ P<0.05）。. 结论: 应用UBE-TLIF治疗单节段MeyerdingⅠ、Ⅱ度腰椎滑脱症微创优势明显，近期疗效满意，远期疗效及安全性有待进一步研究。.
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