ARTRODESE LOMBAR MINIMAMENTE INVASIVA E PARAFUSOS PEDICULARES PERCUTÂNEOS: REVISÃO SISTEMÁTICA

BENITES, VINICIUS DE MELDAU; SPARAPANI, FABIO VEIGA DE CASTRO; IUNES, EDUARDO AUGUSTO; ONISHI, FRANZ JOOJI; SALATI, THIAGO; CAVALHEIRO, SERGIO; PAZ, DANIEL DE ARAÚJO

doi:10.1590/S1808-185120201904228299

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Coluna/Columna 19 (4) • Oct-Dec 2020 • https://doi.org/10.1590/S1808-185120201904228299 copiar

ARTRODESE LOMBAR MINIMAMENTE INVASIVA E PARAFUSOS PEDICULARES PERCUTÂNEOS: REVISÃO SISTEMÁTICA

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

A revisão sistemática da literatura foi realizada com o objetivo de organizar, avaliar e selecionar evidências a respeito da segurança e eficácia da artrodese percutânea minimamente invasiva com parafusos pediculares percutâneos no tratamento de pacientes com doença degenerativa de disco (e outras patologias da coluna), em comparação com a artrodese convencional. Foram consultadas as bases de dados PubMed, EMBASE e Biblioteca Cochrane para localizar ensaios clínicos e relatos/séries de casos publicados em inglês entre 2014 e 2019. Dentre 197 estudos identificados, depois de seleção usando critérios de inclusão/exclusão, 21 artigos foram escolhidos para leitura na íntegra e usados na presente revisão. Apesar do nível de evidência da maioria dos estudos incluídos dificultar a demonstração de eficácia e superioridade entre as técnicas cirúrgicas revisadas, os achados referentes ao procedimento minimamente invasivo apontam para uma abordagem segura e confiável para o tratamento de doenças lombares. Nível de evidência II; Revisão sistemática da literatura.

Artrodese; Relatos de Casos; Ensaio Clínico; Parafusos Pediculares; Coluna Vertebral; Fusão Vertebral

	Source	Level of evidence	# of participants and sex	Mean age (years)	Diagnosis	Intervention	Control Group	Instrumentation	Graft/Implant	Surgical Time (minutes)	Blood loss (ml)	Adverse events	Follow-up (months)
1	Chachan et al. (2019)¹⁷	4^c	3 (F)	62	1: Spondylolisthesis and stenosis; 2: Disc herniation; 3: Spondylolisthesis and retrolisthesis with disc protrusion	Microscopic anterior neural lumbar decompression with OLIF	N/A	Percutaneous pedicle screws	Cellular allograft	NR	NR	No	1: 6; 2: 3; 3: 6
2	Kim et al. (2018)¹⁸	1^a	37 (F) 41 (M)	40-80	Degenerative spinal disease with lumbar stenosis	Robot PLIF	Freehand PLIF	Pedicle screws	Subproducts of the local lamina and facet joint bone + DBM	Robot-PLIF: 220.1 ± 55.9; Freehand-PLIF: 189.8 ± 45.1	NR	Freehand-PLIF: violation by screw and irritation of the nerve root	12
3	Anand et al. (2017)¹⁹	4^c	1 (F)	66	Adult spinal deformity	Minimally invasive circumferential protocol	N/A	Percutaneous pedicle screws	Local bone graft, RhBMP-2 and DBM	NR	NR	Abdominal discomfort	24
4	Coe et al. (2016)²⁰	4^c	1 (F)	75	Spondylolisthesis, spinal stenosis, and collapse of the disc space	TLIF	N/A	Cage and pedicle screws	Allograft	NR	100	No	3
5	Maruo et al. (2016)²¹	4^c	1 (F)	61	Lumbar disc herniation	TLIF	N/A	PEEK cage and percutaneous pedicle screws	Autologous bone graft	NR	300	Hemothorax	0.46
6	Wang et al. (2016)²²	4^c	1 (F)	68	Lumbar tuberculosis	Antituberculosis drugs, minimally invasive debridement and XLIF	N/A	Percutaneous pedicle screws	Autologous bone graft	220	500	No	12
7	Dailey et al. (2015)²³	4^c	1 (F)	24	Idiopathic scoliosis	Minimally incisional posterior fusion	N/A	Pedicle screws	Implant	NR	NR	Pseudoarthrosis	6
8	Kim et al. (2015)²⁴	1^a	21 (F) 19 (M)	Rom-PLIF: 64.4 ± 11.9; Cop-PLIF: 64.7 ± 8.6	Degenerative listhesis, lytic listhesis, foraminal and central stenosis	Rom-PLIF	Cop-PLIF	Pedicle screws	NR	Rom-PLIF: 217.75 ± 33.9; Cop-PLIF: 195 ± 46.9	NR	NR	NR
9	Sarwahi et al. (2015)²⁵	4^c	2 (F)	12.2	Neuromuscular scoliosis	1 – Posterior spinal fusion; 2 – Spinal deformity correction surgery	N/A	Pedicle screws	Allograft and autograft mixed with vancomycin in powder form	1: 300; 2: 420	1: 600; 2: 800	NR	NR
10	Brodano et al. (2014)²⁶	4^c	1 (F)	18	Adolescent idiopathic scoliosis type 1AN (Lenke)	Corrective surgery by minimally invasive fusion	N/A	Posterior pedicle screws	Bone graft from facet joint osteotomy and homologous bank	180	550	NR	12
11	Tender (2014)²⁷	4^c	2 (M)	67	Spondylolisthesis	1: Lumbar fusion; 2: Autonomous lateral lumbar fusion	N/A	1: Cage and plate; 2: Cage	Allograft	1: 60; 2: 45	NR	1: Coronal fracture and collapse of cage in the vertebral body; 2: Coronal fracture and collapsed cage	1: > 18; 2: 12
12	Wang et al. (2014)²⁸	2^b	56 (F) 25 (M)	55,3	Lumbar canal stenosis, spondylolisthesis, or post-laminectomy instability	MIS-TLIF	Open TLIF	MIS-TLIF: PEEK cage and percutaneous pedicle screws; open TLIF: cage and pedicle screws	MIS-TLIF: Autologous bone graft; open TLIF: NR	MIS-TLIF: 127 ± 25; open TLIF: 168 ± 37	MIS-TLIF: 274 ± 99; open TLIF: 645 ± 163	MIS-TLIF: 2 cases of dural rupture. Both: one case of non-union	36,1
13	Ntourantonis et al. (2018)²⁹	4^c	1 (F)	76	Vertebral fracture from osteoporosis with invasion of the spinal canal	Less invasive corpectomy and 360⁰ fusion	N/A	Pedicle screws	NR	NR	Yes	Postoperative bleeding	0.23
14	Fomekong et al. (2018)³⁰	4^c	1 (M)	60	Spondylodiscoarthrosis	TLIF	N/A	Percutaneous pedicle screws	NR	NR	NR	Ureteral perforation	5
15	Agarwal et al. (2016)³¹	4^d	3 (F) 4 (M)	29	Thoracolumbar burst fracture	Fixation with percutaneous pedicle screws	N/A	Percutaneous pedicle screws	Graft of corticocancellous bone and DBM	NR	NR	Hemorrhage due to violation by the screw	25.7
16	Suratwala et al. (2016)³²	4^c	1 (F)	72	Kyphoscoliosis	DLIF	N/A	Percutaneous pedicle screws and rod fixation	NR	240	150	Acute renal infarction	12
17	Funao et al. (2016)³³	4^c	2 (M)	74	Lumbosacral spondylodiscitis	1: MIS; 2: MIS and anterior fusion	N/A	1: Pedicle screws + percutaneous S2AI screws; 2: percutaneous S2AI screws	1: NR; 2: iliac bone graft	1: 188; 2: 178	1: 26; 2: 171	NR	NR
	Source	Level of evidence	# of participants and sex	Mean age (years)	Diagnosis	Intervention	Control Group	Instrumentation	Graft/Implant	Surgical Time (minutes)	Blood loss (ml)	Adverse events	Follow-up (months)
18	Phan et al. (2015)³⁴	4^c	1 (M)	72	Isthmic spondylolisthesis	Autonomous ALIF	N/A	Percutaneous pedicle screws	ANCHOR-L Implant	NR	60	Fracture across the sacral promontory and listhesis	12
19	Wakita et al. (2015)³⁵	4^c	1 (M)	80	Severe kyphoscoliosis and gait disorder	OLIF	N/A	Cage and percutaneous pedicle screws	NR	300	378	Reduced muscle strength	3
20	Staub et al. (2015)³⁶	4^c	1 (M)	51	Achondroplastic dwarfism	Arthrodesis	N/A	Cage and pedicle screws	Lateral graft	NR	NR	No	0.69
21	Chin et al. (2015)³⁷	4^c	2 (F)	49.5	1: Herniated central nucleus pulposus with annular fissure and disc desiccation; Possible hemilaminectomy defect, herniated nucleus pulposus with severe stenosis, disc collapse, and terminal plate changes	1: Lumbar fusion with percutaneous pedicle screws; 2: Decompression and lumbar fusion with percutaneous pedicle screws (open procedure)	N/A	1: PEEK cage and percutaneous pedicle screws 2: Pedicles	NR	NR	NR	NR	1: NR; 2: 11

Source	Main conclusions
Kim et al. (2018)^a	Need for more extensive follow-up, considering that the outcomes did not differ between the groups
Kim et al. (2015)^a	Adequacy of the quality control for robot-assisted pedicle screw fixation
Wang et al. (2014)^a	MIS-TLIF is a safe and reliable procedure for the treatment of obese and overweight patients as compared to the open procedure.
Chachan et al. (2019)^b	Decompression combined with oblique lumbar fusion is feasible and safe.
Anand et al. (2017)^b	A protocol with various minimally invasive techniques can be safe and effective for adult spinal deformity.
Coe et al. (2016)^b	The use of a multiexpandible cage allows a less invasive approach with satisfactory short-term clinical results.
Maruo et al. (2016)^b	First report of hemothorax following MIS-TLIF caused by rod with trocar tip. Attention to the insertion of the rod is necessary at the thoracolumbar levels.
Wang et al. (2016)^b	Extreme lateral fusion with pedicle screw can be an effective treatment for lumbar tuberculosis in the elderly.
Dailey et al. (2015)^b	Attention to the possibility of caudal migration after rod fracture.
Sarwahi et al. (2015)^b	The minimally invasive approach seems to offer benefits to patients with neuromuscular scoliosis.
Brodano et al. (2014)^b	The minimally invasive approach for the treatment of adolescent idiopathic scoliosis demonstrates deformity correction and advantages, but long-term data is needed.
Tender (2014)^b	Attention to the caudal vertebral fracture as a potential complication following minimally invasive lumbar fusion.
Ntourantonis et al. (2018)^b	Attention must be paid to signs of postoperative bleeding and hematomas.
Fomekong et al. (2018)^b	Attention to ureteral injury, considering its serious consequences.
Suratwala et al. (2016)^b	In patients with atherosclerosis, the lateral approach to the anterior lumbar spine may induce occlusion of the renal artery and renal infarction.
Funao et al. (2016)^b	Improvement of the clinical outcomes and percutaneous rigid stabilization of the lumbosacral spine. More in-depth investigations are necessary.
Phan et al. (2015)^b	Fusion is critical to achieving good functional results in isthmic spondylolisthesis with neurological symptoms.
Wakita et al. (2015)^b	The use of minimally invasive OLIF demonstrated advantages for the treatment of degenerative kyphoscoliosis in a patient with Parkinson’s disease.
Staub et al. (2015)^b	Apparently safe approach for achondroplastic dwarfism.
Chin et al. (2015)^b	Highly successful placement of pedicle screws
Agarwal et al. (2016)^c	Fixation with percutaneous pedicle screws may provide lasting benefits, although more in-depth investigations are necessary.

Sociedade Brasileira de Coluna Al. Lorena, 1304 cj. 1406/1407, 01424-001 São Paulo, SP, Brasil, Tel.: (55 11) 3088-6616 - São Paulo - SP - Brazil
E-mail: coluna.columna@uol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Vinicius de Meldau Benites. Rua Napoleão de Barros, 715, sexto andar, Vila Clementino, São Paulo, SP, Brasil. vmbenites@hotmail.com