Lower Incidence of ASP Requiring Surgery With Minimally Invasive TLIF Than With Open PLIF: A long-term Analysis of Adjacent Segment Survival.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-27 DOI:10.1097/BSD.0000000000001741

Young-Ho Roh, Jaewan Soh, Jae Chul Lee, Hae-Dong Jang, Sung-Woo Choi, Byung-Joon Shin

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Abstract

Study design: Retrospective analysis.

Objective: To assess the incidence of and risk factors for adjacent segment pathology (ASP) requiring surgery among patients previously treated with spinal fusion. Survival of the adjacent segment was compared in patients undergoing open posterior lumbar interbody fusion (O-PLIF) versus minimally invasive transforaminal interbody fusion (MI-TLIF).

Summary of background data: Compared with O-PLIF, MI-TLIF may reduce ASP in the long term by preserving more of the paraspinal muscle and ligamentous structures connected to adjacent segments.

Methods: The study population consisted of 740 consecutive patients who had undergone lumbar spinal fusion of 3 or fewer segments. O-PLIF was performed in 564 patients, and MI-TLIF in 176 patients. The incidence and prevalence of revision surgery for ASP were calculated using the Kaplan-Meier method. A risk factor analysis was performed using the log-rank test and a Cox regression analysis.

Results: After index spinal fusion, 26 patients (3.5%) underwent additional surgery for ASP. Kaplan-Meier analysis predicted a disease-free survival rate of adjacent segments in 87.2% at 10 years after the index operation. The incidence of ASP requiring surgery within 10 years was 16.4% after O-PLIF and 6.1% after MI-TLIF (P=0.045). This result was supported by the Cox regression analysis, which showed a significant difference between MI-TLIF and O-PLIF (P=0.034). The hazard ratio of revision surgery was about 3 times higher with O-PLIF than with MI-TLIF. Patients 65 years or older at the time of the index operation were 2.9 times more likely to undergo revision surgery than those younger than 65 years (P=0.015).

Conclusions: MI-TLIF results in less ASP requiring surgery than O-PLIF. 65 years or older is an independent risk factor for ASP. By preserving the soft tissues, MI-TLIF may result in a lower incidence of ASP than the open technique.

Level of evidence: Level 3.

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微创 TLIF 比开放 PLIF 需要手术的 ASP 发生率更低：邻近节段存活率的长期分析

研究设计回顾性分析：评估曾接受脊柱融合术治疗的患者中需要手术的邻近节段病变（ASP）的发生率和风险因素。比较开放后路腰椎椎间融合术（O-PLIF）与微创经椎间孔椎间融合术（MI-TLIF）患者邻近节段的存活率：背景数据摘要：与 O-PLIF 相比，MI-TLIF 可以保留更多的脊柱旁肌肉和与相邻节段相连的韧带结构，从而长期减少 ASP：研究对象包括 740 名连续接受 3 节段或 3 节段以下腰椎融合术的患者。564名患者接受了O-PLIF，176名患者接受了MI-TLIF。采用 Kaplan-Meier 法计算了因 ASP 而进行翻修手术的发生率和流行率。使用对数秩检验和 Cox 回归分析进行了风险因素分析：结果：指数脊柱融合术后，有26名患者（3.5%）因ASP接受了额外手术。Kaplan-Meier分析预测，指数手术后10年，邻近节段的无病生存率为87.2%。O-PLIF术后10年内需要手术的ASP发生率为16.4%，MI-TLIF术后为6.1%（P=0.045）。这一结果得到了Cox回归分析的支持，该分析显示MI-TLIF和O-PLIF之间存在显著差异（P=0.034）。O-PLIF的翻修手术危险比约为MI-TLIF的3倍。指数手术时年龄在65岁或以上的患者接受翻修手术的几率是65岁以下患者的2.9倍（P=0.015）：结论：与O-PLIF相比，MI-TLIF导致需要手术的ASP更少。65岁或以上是ASP的独立风险因素。通过保留软组织，MI-TLIF可能比开放技术导致更低的ASP发生率：证据等级：3 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.