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2013년 9월 13일 금요일

Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?

1st journal review

*Title: Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?

*Author: Sheng-Dan Jiang, Jiang-Wei Chen, Lei-Sheng Jiang

*Bibliography: Arch Orthop Trauma Surg (2012) 132:1259-1266

Abstract
Introduction: This systematic review investigated whether surgical complications, non fusion rate, radiographic outcome and clinical outcome of ALIF were significantly different from those of TLIF.


Method: using MEDLINE data base.
>Eligibility criteria
selecting those articles: 1) target population, individuals: with lumbar spondylosis
2) intervention: ALIF compared with TLIF
3) English written article
and only the most recent papers were used..

>Identification of study
-Publications comparing ALIF and TLIF in the management of lumbar spondylosis were identified from a MEDLINE search. (1966.1~2011.6)
-using OVID search engine
-keyword: ALIF, TLIF, lumbar spondylosis

>Review method : Two authors reviewed the article using below method
1) review the title --> the article might meet eligibility criteria? -->2) then abstract review
-->3) review the complete article.
(only review the method section and blinded with author, institution, journal, results.)

>Statistical analysis
-using SPSS, unpaired Student's t test, Mann-Whitney U test/ Chi-squared test. ( p < 0.05 )


Result
-9 studies(comparing ALIF and TLIF) included in this systematic review.

1) Operative Time (7 studies)
ALIF >>>>>> TLIF

 2) Blood loss (7 studies)
ALIF >>>>>> TLIF

3) Complications (5 studies)
ALIF: 60 complications /244 patients
TLIF: 90 complications /371 patients

4) Radiographic outcomes: disc height, segmental lordosis, whole lumbar lordosis (3 studies)
ALIF >> TLIF

5) Clinical outcomes: using VAS(visual analog scale), ODI (oswestry disability index) (3 studies)
no significant difference

6) Nonfusion
ALIF: 23 /169 patients (13.6%)
TLIF: 23 /222 patients (10.4%)
no significant difference

7) Economic analysis
costs of ALIF were greater than those of TLIF.


Conclusion
OP Time and Blood loss, Radiographic outcomes, costs : ALIF > TLIF
Clinical outcomes and Nonfusion rate: ALIF ≒ TLIF