The Study Of Lumbar Spinal Interbody Fusion By MAST Quadrant System In The Treatment Of Lumbar Disc Herniation With Degenerative Instability

ObjectiveTo explore the surgical injuries, clinical effect, fusion rate, adjacent segment degeneration and complication of lumbar spinal interbody fusion by MAST Quadrant system in the treatment of lumbar disc herniation with degenerative instability, which in order to provide the basis of the demonstration about the operation of surgical and clinical search in the treatment of lumbar disc herniation with degenerative instability.MethodsReviews 70 patients who with lumbar disc herniation went with degenerative instability were treated with posterior lumbar decompression, intervertebral fusion and pedicle screw fixation. All case were collected from Traditional Chinese Hospital of Guangdong, from March 2009 to December 2012.35 patients of them were treated by MAST Quadrant in wiltse approach. The other 35 patients were treated by midline approach for lumbar spinal interbody fusion. To record and compare the size of the wound, blood loss in the operation, fluid volume after the operation, improvement rate of the JOA, Oswestry Disability index (ODI) score, fusion rate, adjacent segment degeneration and complications between this two groups.ResultsIn this study, there were 35 patients in the minimally invasive group, 3 patients were lost to follow-up,1 case death,2 cases address failure; 13 cases of man,19 cases of women; Aged between 37 to 73 years old, the average age was (52.81±9.81) years old; Follow-up time between 25 to 71 months, with an average follow-up time (38.91±13.4) months; 27 patients were treat for single semental,5 patients were treat for double segmental, average section of section (1.16±0.37); Length of hospital stay between 6 to 43 days, the average length of hospital stay (16.94±7.63) days. There were 35 patients in the open group,2 patients were lost to follow-up,1 cases address failure, 1 case refused to follow-up; 16 cases of man,17 cases of women; Aged between 11 to 77 years old, the average age was (57.36±+14.39) years old; Follow-up time between 27 to 60 months, with an average follow-up time (41.97±10.658) months; 26 patients were treat for single segmental,7 patients were treat for double segmental, average section of section (1.21±0.42); Length of hospital stay between 11 to 34 days, the average length of hospital stay (18.42 ±4.70) days. In this two groups in gender, age, and follow-up time, surgical segment, the length of time differences, no statistical significance (P>0.05), baseline balance between this two groups.The size of the wound, blood loss in the operation, fluid volume after the operation were reduced from the minimally invasive group versus the open group, which had statistically significant difference (P<0.05). Minimally invasive and open group of patients with preoperative waist and leg VAS score, JOA score and ODI index has no statistical significance (P>0.05), baseline balance between two groups. In the last follow-up, VAS score and ODI index were decreased, and JOA score were raised, for both group, which has significant difference statistically (P<0.01). Two groups of postoperative VAS, JOA, JOA period, ODI index and fusion rate were no significant statistical difference (P> 0.05). Two groups of adjacent segment degeneration were statistically significant differences (P<0.05), and there was no statistically significant difference of complication rate (P>0.05).ConclusionIn this study, MAST Quadrant in wiltse approach for lumbar spinal interbody fusion compare with midline approach for lumbar spinal interbody fusion to treat for with lumbar disc herniation went with degenerative instability patients has small surgical trauma and low rate of adjacent segment degeneration. Both on the length of hospital stay, clinical efficacy, spinal fusion and complications of results are similar, but the long-term efficacy problems still need further observation.