関節鏡支援単孔脊椎手術 vs MIS-TLIFによる単一レベル安定変性腰椎辷り症：前向きコホート研究

Study designA prospective nonrandomized observational cohort study.ObjectiveTo compare the clinical efficacy of arthroscopic-assisted uniportal spinal surgery combined with unilateral laminotomy bilateral decompression (AUSS-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment stable degenerative lumbar spondylolisthesis (DLS).MethodsA total of 168 patients (AUSS-ULBD n = 86, MIS-TLIF n = 82) with single-segment stable DLS were included. The patients were followed up for at least 2 years. The primary outcome was Oswestry disability index (ODI). Other perioperative indicators, clinical, and radiological outcomes were also compared.ResultsFor ODI, the adjusted mean differences (AUSS-ULBD minus MIS-TLIF) were 1.20 (95% CI -0.85 to 3.25) at 3 months, -1.74 (-3.65 to 0.17) at 12 months, and -0.68 (-2.79 to 1.43) at 24 months. The excellent and good rates of efficacy for the AUSS-ULBD and MIS-TLIF groups were 90.7% and 93.9%, respectively. AUSS-ULBD group had a higher reoperation rate than MIS-TLIF group (difference 4.7%, 95% CI -2.7% to 11.4%, P > .05). The operation time, blood loss, incision length, and hospital stay in the AUSS-ULBD group were lower than those in the MIS-TLIF group (P < .001). At 24 months, lumbar lordosis and slippage improved significantly after MIS-TLIF (P < .05), but not after AUSS-ULBD (P > .05).ConclusionsIn single-level, stable DLS, AUSS-ULBD offered advantages in operative morbidity, while achieving 2-year improvements in pain and disability that were comparable to those of MIS-TLIF. By contrast, MIS-TLIF showed better radiographic correction and lower reoperation rate that did not reach statistical significance.