Comparison in efficacy and safety between endoscopic lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in treatment of degenerative lumbar spinal stenosis
Comparison in efficacy and safety between endoscopic lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in treatment of degenerative lumbar spinal stenosis
Objective To evaluate the efficacy and safety of endoscopic lumbar interbody fusion(Endo-LIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of degenerative lumbar spinal stenosis(DLSS).Methods A total of 114 patients with DLSS from July 2020 to December 2022 were retrospectively analyzed and divided into Endo-LIF group and MIS-TLIF group according to surgical methods using propensity score for 1∶1 matching,excluding mismatched patients,with 53 patients in each group.The operation time,intraoperative blood loss,postoperative drainage volume,postoperative time getting out of bed,hospital stay,fusion and complications of the 2 groups were recorded and compared.The levels of epinephrine E,cortisol,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)were detected before and 1 d and 3 d after surgery.The visual analogue scale(VAS)score was used to evaluate the intensity of low back pain and leg pain before and 7 d,3 months after surgery.The Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score were used to evaluate the lumbar function.The intervertebral height,lumbar lordosis angle,dural sac cross-sectional area and foramen area were measured on whole spine roentgenograph.Results All the operations were successfully completed and the patients were followed up for 12 months.The intraoperative blood loss and postoperative drainage volume in Endo-LIF group were lower than those in MIS-TLIF group,and the operation time,postoperative time getting out of bed and hospital stay were shorter than those in MIS-TLIF group,all with a statistical significance(P＜0.05).The levels of prostaglandin E,cortisol,CRP and TNF-α in the 2 groups at postoperative 1 and 3 d were higher than those before surgery,and the above traumatic stress indexes at postoperative 1 and 3 d in Endo-LIF group were lower than those in MIS-TLIF group,all with a statistical significance(P＜0.05).The VAS score of lower back pain and leg pain,ODI and JO A score in the 2 groups at postoperative 7 d and 3 months were significantly improved compared with those before surgery,and the improvements in Endo-LIF group were more obvious than those in MIS-TLIF group,all with a statistical significance(P＜0.05).The intervertebral height,lumbar lordosis angle,dural sac cross-sectional area and foraminal area in the 2 groups at postoperative 7 d and 3 months were improved compared with those before surgery,all with a statistical significance(P＜0.05).However,there was no statistical significance in the above indexes between the 2 groups(P＞0.05).The incidence of complications in Endo-LIF group was lower than that in MIS-TLIF group,and the difference was statistically significant(P＜0.05).Both groups achieved 100％fusion after surgery.Conclusion Compared with MIS-TLIF,Endo-LIF in the treatment of DLSS can shorten the operation time,reduce the amount of intraoperative blood loss and postoperative drainage volume,accelerate the rehabilitation process,reduce the intensity of traumatic stress and pain,promote the recovery of lumbar function,and with a lower incidence of complications,thus having obvious advantages and being worthy of clinical promotion.
维普
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