Ko, Myeong Jin
(Department of Neurosurgery, Chung-Ang University Hospital)
,
Park, Seung Won
(Department of Neurosurgery, Chung-Ang University Hospital)
,
Kim, Young Baeg
(Department of Neurosurgery, Chung-Ang University Hospital)
Objective : In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for...
Objective : In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS. Methods : We enrolled patients with symptomatic DS at L4-5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods. Results : Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA ($18.9^{\circ}$ and $15.6^{\circ}$) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively. Conclusion : LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.
Objective : In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS. Methods : We enrolled patients with symptomatic DS at L4-5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods. Results : Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA ($18.9^{\circ}$ and $15.6^{\circ}$) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively. Conclusion : LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.
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문제 정의
This study was a single-center study in which the surgeries were conducted by two neurosurgeons (Y.B.K. and S.W.P.). TLIF was performed only by Y.
제안 방법
We retrospectively reviewed and enrolled patients with symptomatic DS who underwent TLIF (TLIF group) or MIS-LLIF (LLIF group) at the L4–5 level between January 2011 and December 2015 and were followed-up for more than one year. Age, sex, bone marrow density, and body mass index were evaluated. This study was reviewed and approved by the Institutional Review Board (CAUH IRB No.
All radiologic measurements were made using the measuring tool within the picture archiving communication system in Chung-Ang Univertisy Hospital. Two observations were made at an interval of at least one week by two neurosurgeons (M.J.K. and S.W.P.), and the mean values were used for the study. The intraclass correlation coefficient (ICC) was checked to verify the intra-observer and inter-observer reliability of the radiologic measurements.
데이터처리
The outcomes between the DLIF and OLIF groups were compared using Student’s t- and chi-square tests.
The radiological and clinical outcomes were compared in each group using paired t-tests. The outcomes between the DLIF and OLIF groups were compared using Student’s t- and chi-square tests.
이론/모형
The radiologic parameters were evaluated at preoperative (Preop), immediate postoperative (Postop), 1 YA, and last f/u. All radiologic measurements were made using the measuring tool within the picture archiving communication system in Chung-Ang Univertisy Hospital. Two observations were made at an interval of at least one week by two neurosurgeons (M.
We assessed the clinical outcomes by using the visual analog scale (VAS) for back pain (VAS-back) and leg pain (VASleg), as well as the Oswestry disability index (ODI). VAS and ODI were evaluated preoperatively (PreVAS and PreODI) and one year postoperatively (PostVAS and PostODI).
성능/효과
In four patients with screw loosening, the PostVAS-back, PostVAS-leg, and PostODI were 5.5±1.3, 3.5±0.8, 26.3±3.5%, respectively, which was not good.
They reported high mean improvements in pain (73% and 64% in back pain, 79% and 74% in leg pain), disability (53% and 57%), and quality of life (63% and 64%) in both the TLIF and XLIF groups, with no significant differences between the two groups. In our study, PostVAS-back and PostVAS-leg were improved by 71.1% and 70% in the TLIF group, respectively, and by 74.7% and 75.8% in the LLIF group, respectively. In addition, PostODI was improved by 59.
0% at last f/u in TLIF and LLIF groups, respectively. The fusion rate on CT scan was 92.7% and 92.3% at 1 YA in the TLIF and LLIF groups, respectively, and there was no significant difference between the two groups on plain radiography and CT.
25) reported the clinical outcomes of TLIF and XLIF in patients with DS. They reported high mean improvements in pain (73% and 64% in back pain, 79% and 74% in leg pain), disability (53% and 57%), and quality of life (63% and 64%) in both the TLIF and XLIF groups, with no significant differences between the two groups. In our study, PostVAS-back and PostVAS-leg were improved by 71.
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