Microscopy-assisted minimally invasive surgery transforaminal lumbar interbody fusion in the treatment of single lumbar spondylolisthesis
Objective To investigate the efficacy of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single segment lumbar degenerative spondylolisthesis by microscopy-assisted Quadrant channel combined with percutaneous pedicle nail fixation.Methods From April 2018 to March 2021,the clinical data of patients with single-level lumbar degenerative spondylolysis who underwent interbody fusion were retrospectively analyzed.Forty-one patients were treated by open transforaminal lumbar interbody(TLIF)(open group),25 patients were treated by TLIF through Quadrant channel via the Wiltse approach(minimally-invasive group),and 38 patients were treated by compression and percutaneous pedicle screw TLIF(microscopic group).The operation time,intraoperative blood loss,fluoroscopy times,drainage volume,visual analogue scale(VAS)of pain around the incision at 2 and 7 days after operation,and complications were recorded in the three groups.The accuracy of pedicle screw placement was evaluated by postoperative CT.Japanese Orthopaedic Association(JOA)scores and Oswestry Dability Index(ODI)were evaluated before operation and at 6 and 24 months after operation.Results Compared with the minimally-invasive group and the open group,the microsurgical group had less intraoperative blood loss,smaller drainage volume,and lower VAS scores of pain around the incision at 2 and 7 d after operation.The accuracy of pedicle screw placement was higher in the microscopic group than in the other two groups(P＜0.05),but more intraoperative X-ray fluoroscopies were required(P＜0.05).There were one case of superficial soft tissue infection,one case of suspected infection,and one case of cerebrospinal fluid leakage in the open group,and two cases of transient neurological symptoms in the minimally-invasive group.The JOA and ODI scores of the three groups at 6 and 24 months after operation were significantly improved compared with those before operation(P＜0.05),and there was no significant difference between the groups(P＜0.05).There were no significant differences in fusion rate at 6 and 24 months after operation between the three groups(P＞0.05).According to the modified MacNab criteria,there was no significant difference in the excellent and good rates of curative effect among the three groups(P＞0.05).Conclusions Microscopically-assisted MIS-TLIF for the treatment of single segment lumbar degenerative spondylolysis results in less bleeding,less incision pain and fewer complications.Percutaneous pedicle screw placement is highly accurate.The fusion rate and the excellent and good curative effect rates are the same as those of open surgery.The clinical outcome is good.
万方数据
维普
