Retrospective Clinical Comparison Of Mini-TLIF Via Quadrant Minimally Invasive System Versus Open-TLIF In The Treatment Of Lumbar Degenerative Disease

Objective: lumbar degenerative disease is based on Intervertebral discdegeneration.caused related symptoms of local instability, disc herniation,spinal canal stenosis, etc. Then cause the related progress of the diseaseprocess of lumbar instability, spondylolisthesis, side scoliosis. With lumbardegenerative disease rate increased year by year, the cause of back and legpain plagued by more and more old patients, it has become a clinical commonand frequently-occurring disease. Intervertebral disc is the no blood supplyorgan in human body, and their own repair ability is poor, so conservativetreatment method often can not reach the anticipated treatment effect afterdegeneration of lumbar intervertebral disc, which requiressurgery.Transforaminal lumbar interbody fusion(TLIF) produced in the early1980s, compared with the traditional posterior lumbar interbody fusion, TLIFhas its unique advantages, and it is widely used in clinical.With thedevelopment of minimally invasive spinal surgery,the treatment of lumbardegenerative disease also produced some new minimally invasive methods,and had made the good clinical effect.Mast Quadrant minimally invasivesurgery system is a new type of minimally invasive surgery system which isbased on the X-Tube and MED. Transforaminal lumbar interbody fusion viaQuadrant minimally invasive system is gradually popularized a new clinicalsurgical method of treatment of lumbar degenerative disease, it welcomed bymasses of spine surgeons and patients increasingly. By comparing the analysisof the two groups indicators of this surgery and clinical symptomsimprovement, we would discuss the clinical effects of mini-TLIF via Quadrantminimally invasive system and traditional open-TLIF on treating single gapdegenerative lumbar disease. Methods: From November2011to February2012, a total of45patientswith single level lumbar degenerative disease were divided into2groupsrandomly。Twenty patients in group1underwent mini-TLIF via Quadrant minimallyinvasive system.After systemic anesthesia successfully，we made patientstaken the prone position with hollow cushion under the chest andabdomen.Accurately located the lesions vertebral segment and the upper andlower pedicle roots with C-arm X-ray,and marked on skin.We disinfected skinroutinely and blanketed sterile towels.We made a longitudinal incision about3cm along with pedicles connection on the main symptom side,then cut theskin,subcutaneous tissue and fascia,and dissected tissue bluntly with naturalgap between the multifidus and longissimus.We touched vertebral plates spaceby hand,placed progressive expansion sleeve,and placed Quadrant minimallyinvasive system produced by Sofamor. Exposure to the operation field,surgeonstop bleeding carefully,removed tissue and inferior articular process,separatedepidural ligamentum flavum. Protection and release the nerve root, surgeonwould further expaned the nerve root canal,cut annulus fibrosus,remove thenucleus pulposus and the intervertebral disc tissues.After normal salineirrigation the intervertebral space,we filled in the intervertebral space withautologous bones, suppressed the bones to the front of the intervertebral spaceand implanted one Cage containing the autologous bones.Surgeon placedgelatin sponge on the surface of dura mater.We implanted four pediclescrews,and made them firmly with the connecting levers.Their positions weregood on the C-arm X-ray.Finally surgeon placed vacuum aspiration and sutureincision.Twenty-five cases in2group underwent open-TLIF. After systemicanesthesia successfully，we made patients taken the prone position withhollow cushion under the chest and abdomen.Surgeon would take lumbarposterior midline incision about7~10cm in the center of the lesionintervertebral space. Then we cut the skin,subcutaneous tissue and fascia,stopbleeding and dissected paravertebral muscles to articular process. We implanted four pedicle screws, made standard TLIF,then filled in theintervertebral space with autologous bones and one Cage. We made pediclescrews firmly with the connecting levers. Surgeon placed vacuum aspirationand suture incision at last.In45cases of lumbar single level degenerative disease, including27cases of male,18cases of female, age from22~70years old, an average of47.3years old. The application of statistics analysis of the indicators comparedbetween the two groups, including the length of surgical incision, operatingtime, blood loss, volume of drainage after operation, and time of ambulation,hospital stay after surgery, Visual Analogue Scale score(VAS),Oswestry Disability Index (ODI).Results: Length of incision, blood loss, volume of drainage afteroperation，time of ambulation, and length of stay were significantly better formini-TLIF than open-TLIF cases. All patients were followed up for one year.In patients VAS score and ODI score showed significantly better improvementat1week,1month,3month,6month for mini-TLIF versus open-TLIFpatients, but were similar at1year after surgery.Conclusion: Mini-TLIF via Quadrant minimally invasive system couldshow less operation trauma, blood less, accelerated recovery and satisfiedshort-term effect. It provides a new choice for the treatment of lumbardegenerative disease, it is a safe and reliable minimally invasive method.