Study Design: 

This was a retrospective cohort study.

Objective: 

The objective of this study was to compare radiographic and patient-reported outcome measures (PROMs) between circumferential fusions and transforaminal lumbar interbody fusion (TLIF) for adult isthmic spondylolisthesis (IS).

Summary of Background Data: 

Definitive management of adult IS typically requires decompression and fusion. Multiple fusion techniques have been described, but literature is sparse in identifying the optimal technique.

Methods: 

Patients with IS undergoing single-level or 2-level circumferential fusion or TLIF with a minimum 1-year follow-up were included. Patient demographics, surgical characteristics, and PROMs were extracted from patients’ electronic medical records. Descriptive statistics and multivariate regression analysis compared outcomes with significance set at P-value <0.05.

Results: 

A total of 78 circumferential fusions (48 open decompression and fusions and 30 circumferential fusions utilizing posterior percutaneous instrumentation) and 50 TLIF procedures were included. Length of stay was significantly longer when comparing circumferential procedures (3.56±0.96 d) versus TLIFs (2.88±1.14 d) (P=0.002). The circumferential fusion group resulted in greater postoperative improvement in segmental lordosis [anterior/posterior (A/P): 6.45, TLIF: −1.99, P<0.001], posterior disk height (A/P: 12.6 mm, TLIF: 8.9 mm, P<0.001), and ∆disk height (A/P: 7.7 mm, TLIF: 3.6 mm, P<0.001). Both groups significantly improved in all PROMs (P<0.001). While the circumferential fusion group had a significantly higher rate of perioperative surgical complications (12.82% vs. 2.00%, P=0.049), there was no difference in the rate of 30-day readmissions (P=0.520) or revision surgeries between techniques (P=0.057).

Conclusions: 

Circumferential fusions are associated with improvements in radiographic outcomes compared with TLIFs, but this is at the expense of longer hospital length of stay and increased risk for perioperative complications. The surgical technique did not result in superior postoperative PROMs or differences in readmissions or revisions.

中文翻译：

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成人峡部脊椎滑脱：比较环周融合术与 TLIF 手术的放射学和结果分析

学习规划： 

这是一项回顾性队列研究。

客观的： 

本研究的目的是比较环周融合术和经椎间孔腰椎椎间融合术 (TLIF) 治疗成人峡部脊椎滑脱 (IS) 的放射学和患者报告的结果测量 (PROM)。

背景数据摘要： 

成人 IS 的最终治疗通常需要减压和融合。多种融合技术已经被描述，但在确定最佳技术方面的文献很少。

方法： 

纳入接受单节段或 2 节段环周融合或 TLIF 并至少随访 1 年的 IS 患者。从患者的电子病历中提取患者人口统计数据、手术特征和 PROM。描述性统计和多元回归分析将结果与P值 <0.05设定的显着性进行比较。

结果： 

总共包括 78 例圆周融合术（48 例开放式减压融合术和 30 例利用后路经皮器械的圆周融合术）和 50 例 TLIF 手术。比较圆周手术 (3.56±0.96 d) 与 TLIF (2.88±1.14 d) 时，住院时间明显更长 ( P = 0.002)。环周融合组术后节段前凸[前/后（A/P）：6.45，TLIF：-1.99，P < 0.001 ]、后椎间盘高度（A/P：12.6 mm，TLIF：8.9 mm，P <0.001) 和 Δ盘高度 (A/P: 7.7 mm, TLIF: 3.6 mm, P <0.001)。两组的所有 PROM 均显着改善（P <0.001）。虽然环周融合组的围手术期手术并发症发生率显着较高（12.82% vs. 2.00%，P =0.049），但不同技术之间的 30 天再入院率（ P =0.520）或翻修手术率没有差异（ P =0.057）。

结论： 

与 TLIF 相比，圆周融合与放射学结果的改善相关，但这是以延长住院时间和增加围手术期并发症风险为代价的。手术技术并没有带来更好的术后 PROM 或再入院或翻修方面的差异。