Comparison Of Paraspinal Intermuscular Approach And Conventional Posterior Approach On Treatment Of L5/S1Single-level Lumbar Disc Herniation

Objective: Since the conventional posterior approach with lumbar interbody fusion need to strip the paraspinal muscle widely, it tends to be invasive with postoperative complication of waist weakness, longer duration in bed and chronic lumbago. On account of the particular characteristic in L5/S1, the conventional posterior approach with lumbar disc herniation on this single‐level show more disadvantages. To evaluate the clinical efficacy of paraspinal intermuscular approach on treatment of L5/S1single‐level lumbar disc herniation, comparison between the paraspinal intermuscular approach and the conventional posterior approach based on32patients are analyzed in this paper.Methods: Clinical material of32patients who had lumbar disc herniation surgery using transforaminal lumbar interbody fusion (TLIF) in L5/S1level was collected from January2011to June2011. Study group comprised15patients who received operations with paraspinal intermuscular approach. Control group included17patients who received operations with conventional posterior approach. Operative duration, blood loss, drainage, postoperative VAS (Visual Analogue Score) within72h, postoperative ODI (Oswestry Disability Index) within1month,6months and12months, postoperative duration in bed and postoperative complication rate were compared separately by statistical analysis. Results: In study group receiving operations with paraspinal intermuscular approach, the average operative duration was (104.80±12.60)min; the average blood loss was134.00±33.55ml; the average drainage was (92.73±13.23)ml; the average postoperative VAS within72h was (1.93±0.59); the average postoperative duration in bed was (2.60±0.38)d; the postoperative ODI within1month,6months and12months were respectively (23.11±6.33)%,(17.33±3.48)%and (8.74±3.08)%; incision poor healing was found in2patients; complication rate was13.3%. In control group receiving operations with conventional posterior approach, the average operative duration was (129.18±33.88)min; the average blood loss was (188.53±57.98)ml; the average drainage was (125.00±53.29)ml; the average postoperative VAS within72h was (3.17±0.88); the average postoperative duration in bed was (4.03±0.69)d; and the postoperative ODI within1month,6months and12months were respectively (31.63±5.00)%,(23.26±4.38)%,(12.68±2.91)%; incision poor healing and cerebrospinal fluid leakage were found in2patients and1patient respectively; complication rate was17.6%. In terms of the average operative duration, the average blood loss, the average drainage, the average postoperative VAS scores and postoperative duration in bed, significant differences were analyzed between two groups (P<0.05), where study group showed better efficacy than control group. By contrast, no significant difference was found in postoperative complication rate (P>0.05).Conclusions: Paraspinal intermuscular approach on treatment of single‐level lumbar disc herniation in L5/S1helps to reduce the invasive, protect paraspinal muscle and fix the pedicle screws, which is regarded as an accurate, minimally invasive and safe option with less pain and recovery time.