A System Assessment Of Clinical Application Of Dynesys And TLIF Compared With PLIF

Objective:To make a system assessment of efficacy and security of different surgical methods in treating degenerative lumbar disease. The research was divided into two parts, the comparison of Dynesys and PLIF was in the first part, the comparison of TLIF and PLIF was in the part two.Materials and methods:The related literatures were collected through PubMed, Medline, Embase, CNKI, Wanfang database, CBM and influential periodicals. The research data was extracted by two researchers independently. The Stata SE11.2was applied to analyze the extracted data.Results:The comparison of Dynesys and PLIF:A total of359cases (159cases for Dynesys,200cases for PLIF) in7literatures was included. The SMD of operation time was-1.34,95%CI:-1.95～-0.73, P<0.001. The SMD of bleeding volume was-1.28,95%CI:-2.18～-0.38, P=0.005. The SMD of postoperative VAS was0.03,95%CI:-0.35-0.41, P=0.880. The SMD of postoperative ODI was-0.07,95%CI:-0.30-0.17, P=0.570. The SMD of operated segment ROM was4.57,95%CI:3.29-5.85, P<0.001. The SMD of adjacent segment ROM was-1.36,95%CI:-2.32～-0.40, P=0.006.The comparison of TLIF and PLIF:A total of1041cases (520cases for PLIF,521cases for TLIF) in12literatures was included. The SMD of operation time was1.26,95%CI:0.58～1.94, P<0.001. The SMD of bleeding volume was1.70,95%CI:0.94-2.46, P<0.001. The SMD of postoperative interspace height was-0.07,95%CI:-0.44-0.30, P=0.730. The OR of surgical complications was4.50,95%CI:2.65-7.64, P<0.001. The SMD of postoperative VAS was-0.07,95%CI:-0.27-0.13, P=0.515. The SMD of postoperative ODI was0.15,95%CI:-0.06-0.35,P=0.155. The OR of JOA improvement rate was1.43,95%CI:0.75-2.73, P=0.280. The OR of fusion rate was1.17,95%CI:0.63-2.15,P=0.616.Conclusion:Dynesys had significant advantages on decreasing operation time and bleeding volume as compared with PLIF. There was no difference in postoperative VAS and ODI between two surgical methods. Dynesys could maintain mobility of operated segment without increasing ROM of adjacent segment.TLIF had significant advantages on decreasing operation time, bleeding volume and risk of surgical complications as compared with PLIF. TLIF and PLIF had the same clinical efficacy on restoring and maintaining postoperative interspace height.