Dejeneratif spondilolistezis için transforaminal lomber interbody füzyon (TLIF) cerrahisinin etkinliğinin klinik sonuçlar ve spinopelvik ölçümlere göre incelenmesi

Abstract

Giriş: Transforaminal lomber interbody füzyon (TLIF) dejeneratif spondilolistezis tedavisinde giderek daha fazla kullanılan bir yaklaşımdır, ancak spinopelvik dizilim ve ilgili fonksiyonel sonuçlar üzerindeki etkisine ilişkin sınırlı veri mevcuttur. Yöntem: Bu çalışmaya TLIF uygulanan 150 hasta dahil edildi ve ameliyat öncesi ve sonrası değerlendirildi. Lomber lordoz (LL), pelvik tilt (PT) ve sakral eğim (SS) dahil olmak üzere spinopelvik parametreleri ölçmek için radyografik analiz kullanıldı. Oswestry Engellilik İndeksi (ODI) ve Görsel Analog Skala (VAS) fonksiyonel sonuçları değerlendirilmiştir. Yöntemler İstatistiksel analizler sırasıyla eşleştirilmiş t-testleri, Pearson korelasyon katsayıları ve ameliyat öncesi ve sonrası parametrelerdeki farklılıklar, spinopelvik parametrelerdeki değişiklikler ile fonksiyonel sonuçlar arasındaki ilişkiler ve ODI'de daha fazla iyileşmenin belirleyicileri için çok değişkenli regresyonu içeriyordu. Bulgular: Ameliyat öncesinden ameliyat sonrası 10. güne kadar LL, PT ve SS'deki değişiklikler, 30 puanlık posterior pelvik düzlem yeniden oryantasyon skoru. Fonksiyonel çıktı değerlendirmeleri ortalama ODI (34'ten 20'ye) ve VAS (6.5'ten 3.2'ye) skorlarında iyileşme gösterdi (p <0.001). Ameliyat öncesi ODI, ameliyat sonrası LL, PT ve SS'deki değişim çok değişkenli regresyon ile şansın üzerinde iyileşmeyi öngörmüştür (p < 0.001). Sonuç: TLIF, spinopelvik dizilimde ve fonksiyonel sonuçlarda düzeltme sağlayarak, her hasta için yaşam kalitesini maksimum değerde optimize etmek için ameliyat öncesi değerlendirmenin ve hedefe yönelik cerrahi planlamanın önemini desteklemektedir. Daha uzun dönem iyileşme ve diğer ilgili sonuç değişkenleri araştırılmalıdır.

Keywords

• transforaminal lomber interbody füzyon
• interbody füzyon
• omurga cerrahisi
• spondilolistezis

Analyzing the efficacy of transforaminal lumbar interbody fusion (TLIF) surgery for degenerative spondylolisthesis based on clinical outcomes and spinopelvic metrics

Abstract

Aims: Transforaminal lumbar interbody fusion (TLIF) is an increasingly used approach for treating degenerative spondylolisthesis, but limited data exist regarding its impact on spinopelvic alignment (SA) and related functional outcomes. Methods: 150 patients who underwent TLIF were enrolled and evaluated pre-operatively and post-operatively in this study. Radiographic analysis was used to measure spinopelvic parameters, including lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS). Oswestry disability index (ODI) and visual analog scale (VAS) functional outcomes were assessed. Methods statistical analyses included paired t-tests, Pearson correlation coefficients, and multivariate regression for differences in parameters before and after surgery, associations between changes in spinopelvic parameters and functional outcomes, and predictors of greater improvement in the ODI, respectively. Results: Changes in LL, PT and SS from pre- to post-operative day 10, 30-points posterior pelvic plane re-orientation score. Functional output assessments showed improvement in mean ODI (34 to 20) and VAS (6.5 to 3.2) scores (p<0.001). Pre-operative ODI, post-operative change in LL, PT and SS predicted recovery above chance by multivariate regression (p<0.001). Conclusion: TLIF provides correction to SA and functional outcomes, supporting the importance of pre-operative assessment and targeted surgical planning to optimize quality of life at maximum value for each patient. Longer-term recovery and other pertinent outcome variables should be conducted.

Keywords

• Transforaminal lumbar interbody fusion
• interbody fusion
• spine surgery
• spondylolisthesis

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