首页>
外文期刊>Neurosurgical focus
>Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease
【24h】
Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease
OBJECTIVE In this study the authors compared the anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) techniques in a homogeneous group of patients affected by single-level L5–S1 degenerative disc disease (DDD) and postdiscectomy syndrome (PDS). The purpose of the study was to analyze perioperative, functional, and radiological data between the two techniques. METHODS A retrospective analysis of patient data was performed between 2015 and 2018. Patients were clustered into two homogeneous groups (group 1 = ALIF, group 2 = TLIF) according to surgical procedure. A statistical analysis of clinical perioperative and radiological findings was performed to compare the two groups. A senior musculoskeletal radiologist retrospectively revised all radiological images. RESULTS Seventy-two patients were comparable in terms of demographic features and surgical diagnosis and included in the study, involving 32 (44.4%) male and 40 (55.6%) female patients with an average age of 47.7 years. The mean follow-up duration was 49.7 months. Thirty-six patients (50%) were clustered in group 1, including 31 (86%) with DDD and 5 (14%) with PDS. Thirty-six patients (50%) were clustered in group 2, including 28 (78%) with DDD and 8 (22%) with PDS. A significant reduction in surgical time (107.4 vs 181.1 minutes) and blood loss (188.9 vs 387.1 ml) in group 1 (p 0.0001) was observed. No significant differences in complications and reoperation rates between the two groups (p = 0.561) was observed. A significant improvement in functional outcome was observed in both groups (p 0.001), but no significant difference between the two groups was found at the last follow-up. In group 1, a faster median time of return to work (2.4 vs 3.2 months) was recorded. A significant improvement in L5–S1 postoperative lordosis restoration was registered in the ALIF group (9.0 vs 5.0, p = 0.023). CONCLUSIONS According to these results, interbody fusion is effective in the surgical management of discogenic pain. Even if clinical benefits were achieved earlier in the ALIF group (better scores and faster return to work), both procedures improved functional outcomes at last follow-up. The ALIF group showed significant reduction of blood loss, shorter surgical time, and better segmental lordosis restoration when compared to the TLIF group. No significant differences in postoperative complications were observed between the groups. Based on these results, the ALIF technique enhances radiological outcome improvement in spinopelvic parameters when compared to TLIF in the management of adult patients with L5–S1 DDD.
展开▼
机译：目的在这项研究中，作者将前腰椎体椎间体融合（ALIF）和后横轮锤肌肌椎体椎间椎体群体融合（TLIF）技术与单级L5-S1退行性椎间盘疾病（DDD）和两位术后综合征影响的均质组（PDS ）。该研究的目的是分析两种技术之间的围手术期，功能和放射数据。方法根据外科手术，在2015和2018之间进行患者数据的回顾性分析。在2015和2018之间进行患者数据。患者将患者聚集成两个均相组（第1次= Alif，第2组= TLIF组）。进行临床围手术期和放射学发现的统计分析以比较两组。高级肌肉骨骼放射学家回顾性修改了所有放射性图像。结果72例患者在人口统计学特征和外科诊断方面是可比的，并包括在研究中，涉及32名（44.4％）男性和40名（55.6％）的女性患者，平均年龄为477岁。平均随访时间为49.7个月。将36名患者（50％）聚集在第1组中，包括31（86％），具有DDD和5（14％）的Pds。在第2组中聚集了36名患者（50％），其中28（78％），具有PDS的DDD和8（22％）。观察到手术时间（107.4 vs181.1分钟）和血液损失（188.9 vs 387.1ml）的显着降低（P <0.0001）。观察到两组（P = 0.561）之间的并发症和再置换率没有显着差异。在两组中观察到功能结果的显着改善（P <0.001），但在最后一次随访中发现了两组之间的显着差异。在第1组中，记录了更快的返回工作时间（2.4 vs 3.2个月）。在AlIF组（9.0 Vs 5.0，P = 0.023）中登记L5-S1术后术后病变修复的显着改善。结论根据这些结果，椎体间融合在致畸疼痛的手术管理中是有效的。即使临床效益在ALIF组（更好的分数和更快地返回工作）中，这两种程序也在最后一次随访时改善了功能性结果。与TLIF组相比，ALIF组显示出血损失，短手术时间较短，手术时间较短，更好的节段性神经病症恢复。在组之间观察到术后并发症的显着差异。基于这些结果，与TLIF在L5-S1 DDD的成年患者管理中，ALIF技术提高了尖刺参数的放射性结果改善。
展开▼
