Study design

Retrospective cohort study.

Objective

To investigate the clinical and radiographic differences between patients who underwent anterior lumber interbody fusion (ALIF) with either open or percutaneous posterior fusion for lumbar isthmic spondylolisthesis.

Summary of background data

Circumferential fusion for isthmic spondylolisthesis is commonly performed with superior clinical outcomes, fusion rates, and restoration of sagittal balance when compared to posterior fusion alone. The outcomes comparing traditional open versus percutaneous posterior fusion in this setting have not been fully evaluated.

Methods

A retrospective review of patients who underwent ALIF with either traditional open or percutaneous posterior fusion for isthmic spondylolisthesis between 2014 and 2019 was conducted. Patient demographics, surgical characteristics, and radiographic and clinical outcomes were compared between groups.

Results

A total of 79 patients were included in the final analysis, with 49 in the Open group and 30 in the Percutaneous group. No differences were found with regard to demographic factors between groups including sex, body mass index (BMI), diabetic status, and smoking status. The percutaneous group had less estimated blood loss (EBL, 69.2 mL) and shorter length of stay (3.06 days) compared to the open group (446 mL, p = 0.017; 3.98 days, p = 0.003). Both groups demonstrated significant improvement in all clinical outcome measures after surgery (PCS-12, MCS-12, ODI, VAS Back, and VAS Leg scores). The percutaneous group achieved greater ∆VAS Back (Open = 3.55, Perc = 5.17; p = 0.045) and also had a significantly greater improvements in recovery ratio for VAS Back (Open: 0.43, Perc: 0.73; p = 0.037) and ODI (Open: 0.40, Perc = 0.67; p = 0.031). Regression analysis demonstrated percutaneous surgery to be significant predictor of superior improvement in VAS Back scores (β = 1.957, p = 0.027).

Conclusion

ALIF with percutaneous posterior fusion affords greater improvement in back pain and disability when compared to ALIF with open posterior fusion for isthmic spondylolisthesis.

Level of evidence

III.

中文翻译：

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开放式与经皮后路环周融合治疗腰椎峡部滑脱

学习规划

回顾性队列研究。

客观的

研究接受前路腰椎椎间融合术（ALIF）与开放或经皮后路融合治疗腰椎峡部滑脱的患者之间的临床和影像学差异。

背景数据摘要

与单纯后路融合相比，峡部脊椎滑脱的环向融合通常具有更好的临床结果、融合率和矢状平衡恢复。在这种情况下比较传统开放与经皮后路融合的结果尚未得到充分评估。

方法

对 2014 年至 2019 年间接受传统开放式或经皮后路融合治疗峡部脊椎滑脱的 ALIF 患者进行了回顾性研究。比较两组患者的人口统计学、手术特征、影像学和临床结果。

结果

最终分析共纳入79例患者，其中开放组49例，经皮组30例。在性别、体重指数 (BMI)、糖尿病状况和吸烟状况等组间的人口统计学因素方面没有发现差异。与开放组（446 mL，p = 0.017；3.98 天，p = 0.003）相比，经皮组估计失血量更少（EBL，69.2 mL）和更短的住院时间（3.06 天）。两组在手术后的所有临床结果指标（PCS-12、MCS-12、ODI、VAS Back 和 VAS Leg 评分）均表现出显着改善。经皮组获得更大的 ΔVAS Back (Open = 3.55, Perc = 5.17; p = 0.045) 并且在 VAS Back (Open: 0.43, Perc: 0.73; p = 0.037) 和 ODI (打开：0.40，Perc = 0.67；p = 0.031）。

结论

与 ALIF 与开放式后路融合术治疗峡部脊椎滑脱相比，经皮后路融合术的 ALIF 在背痛和残疾方面提供了更大的改善。

证据级别

三、