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2013년 9월 20일 금요일

Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation

3rd journal review

*Title: Mini-Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody fusion Augmented by Percutaneous Pedicle Screw Fixation.

*Author: Jin-Sung Kim, MD,  Byung-Uk Kang, MD,  Sang-Ho Lee, MD, PhD,  Byungjoo Jung, MD, PhD,  Young-Gun Choi, MD,  Sang Hyeop Jeon, MD  Ho Yeon Lee, MD, PhD 


*Bibliography: J Spinal Disord Tech. 2009 Apr;22(2):114-21.


Study Design: Retrospective clinical data analysis.

Objective: To compare clinical results with radiologic results of 2 fusion techniques for adult low-grade isthmic spondylolisthesis.


Summary of Background Data: There is clear evidence that comparing ALIF versus PLIF.


However, there are no recent studies that compare these 2 fusion techniques(ALIF and TLIF).

Methods: 
>Patient population
-patient characteristics (2004.03~2004.12)



-inclusion criteria
1) presence of single-level low-grade isthmic spondylolisthesis
2) chronic and persistent radiculopathy despite conservative treatment
3) progressive neurologic deficits
4) persistent and unremitting lower-back pain for more than 6months
5) loss of quality of life because of neurologic claudication
6) minimum follow-up period 2years
7) age range of 18 to 65 years

-exclusion criteria
1) previous spine surgery
2) concomitant scoliosis of more than 15 degrees
3) compression fracture or instability at the adjacent segment
4) underwent simultaneous decompression at adjacent segments

>Outcome assessment
-Radiologic outcome:
evaluated on anteroposterior, lateral, and flexion-extension radiographs.
 Radiologic data: 1)disc height 2) segmental lordosis 3) whole lumbar lordosis 4) degree of listhesis

<radiologic measurement method>


 Clinical outcome: 1) VAS(visual analog scale) 2) ODI(oswestry disability index)

>Surgical Techniques
-All ALIF procedures were performed using the mini-laparotomic retroperitoneal approach.

>Mini-TLIF with PPF


>Statistical Analysis
-An analysis of variance was conducted using the 2 proportions test, independent 2 sample t test, x^test, paired t test. (p<0.05)


Results
>Radiologic results
The postoperative radiologic data revealed below.





















-DH and SL -->  significant difference
-degree of listhesis and WL--> Not  significant difference


>Clinical outcomes
-VAS score
ALIF- back: 7.7 --> 2.9
        leg:    7.5--> 2.7
TLIF- back: 7.0 --> 2.3
        leg:    6.3--> 2.2

-ODI score
ALIF: 51.4%--> 23.2%
TLIF: 52%   --> 14.4%


Conclusions
-The mini-ALIF group demonstrated key radiographic advantages compared with the mini-TLIF group for adult low-grade isthmic spondylolisthesis. 

-However, clinical and functional outcomes did not demonstrate significant differences between groups.