Therapeutic Effectiveness Of MIS-TLIF Assisted By Microscopy For The Treatment Of Lumbar Spondylolisthesis With Spinal Canal Stenosis In The Midlife And Elderly People

BackgroundLumbar spondylolisthesis with spinal canal stenosis is a common spinal degenerative disease which causes the symptoms of backleg or pain.It is common in the middle-aged and elderly people.With the continuous aging of society in China,the incidence of lumbar spondylolisthesis with spinal canal stenosis is increasing year by year.Lumbar spondylolisthesis with spinal canal stenosis can cause stubborn low back pain,neurogenic intermittent claudication,or lower extremity pain,numbness and weakness of the root nerve symptoms,which has a serious impact on patients’ work and daily life.When conservative treatments are not effective for patients,it is often necessary to consider the use of surgical treatment.At present,posterior lumbar interbody fusion is a mainstream operative method for treating lumbar degenerative diseases.Although PLIF can achieve better clinical efficacy in treating lumbar spondylolisthesis,there are many disadvantages such as great operative trauma,bleeding volume during operation,long postoperative bed rest and more complications.In recent years,minimally invasive transforaminal lumbar interbody fusion has been widely applied in the treatment of lumbar degenerative diseases with the development of minimally invasive surgical instruments and minimally invasive techniques.MIS-TLIF has the effect of surgical treatment based on the equivalent with the traditional open operation,and has the advantages of smaller surgical approach,faster postoperative recovery,less intraoperative and postoperative complications.However,MIS-TLIF still has some limitations,such as the operation field under the channel is narrower,which leads to insufficient identification of the local anatomical structures,such as the nerve root,the ligamentum flavum,and the dural sac.The microscope has the advantages of stereoscopic vision,clear image and strong identification of the local anatomical structure,which can better make up the shortcomings of MIS-TLIF.Chen Yuanwu and others believe that MIS-TLIF combined with microscope can improve the accuracy of spinal canal decompression operation and reduce the incidence of iatrogenic injuries such as dura tear and injury of nerve root.We will combine MIS-TLIF with microscope and make full use of their respective advantages,applying to the treatment of lumbar spondylolisthesis with spinal canal stenosis in the midlife and elderly,and compared with the clinical effect of traditional PLIF technology,the difference of the clinical curative effect of the operation was analyzed,so as to provide the basis for the related clinical treatment.ObjectiveTo evaluate the difference of the therapeutic effectiveness of MIS-TLIF assisted by microscopy with PLIF for the treatment of lumbar spondylolisthesis with spinal canal stenosis in the middle-aged and elderly people.MethodsNinety-two patients suffered from the single segment lumbar spondylolisthesis with spinal canal stenosis in the midlife and elderly were selected from May 2016 to May 2017 in the First Affiliated Hospital of Zhengzhou University.According to the different surgical methods,they were divided into minimally invasive and open groups.Patients in the minimally invasive group accepted MIS-TLIF assisted by microscopy.The minimally invasive group had 46 patients,which was comprised of 20 males and 26 females.Their age distribution was from 45 to 69,which had a mean age of 55.92 years and their duration of the disease was from 4 months to 18 months,which had a mean of 10.73 months.There were 25 cases of L4 spondylolisthesis and 21 cases of L5 spondylolisthesis in the minimally invasive group,which comprise 33 cases degenerative lumbar spondylolisthesis and 13 cases isthmic spondylolisthesis.According to the Meyerding classification standard,17 cases were I degree and 29 cases were second degree in the minimally invasive group.Patients in the open group accepted PLIF.The open group had 46 patients,which was comprised of 21 males and 25 females.Their age distribution was from 46 to 71,which had a mean age of 54.83 years and their duration of the disease was from 5 months to 19 months,which had a mean of 11.25 months.There were 26 cases of L4 spondylolisthesis and 20 cases of L5 spondylolisthesis in the open group,which comprise 31 cases degenerative lumbar spondylolisthesis and 15 cases isthmic spondylolisthesis.According to the Meyerding classification standard,18 cases were I degree and 28 cases were second degree in the open group.The operation time,intraoperative blood loss,drain of postoperation,postoperative time of lying in bed and intraoperative complications were observed and compared between the two groups to analysis the difference of surgical related indexes.The preoperative and postoperative visual analogue score(VAS)and Oswestry dysfunction index(ODI)were observed and compared between the two groups to analysis the difference of the treatment effect.At the postoperative third day,postoperative third month and last follow-up,lumbar X-ray and CT were reviewed to analysis the difference of postoperative spondylolisthesis ratio and intervertebral fusion rate between the two groups.ResultsThe 92 patients suffered from the single segment lumbar spondylolisthesis with spinal canal stenosis in the middle-aged and elderly were successfully completed surgery.The intraoperative blood loss and drain of postoperation in the minimally invasive group were significantly smaller than those in the open group,and the difference was statistically significant(P<0.05).There was no significant difference in operative time between the two groups(P>0.05),but the postoperative time of lying in bed was significantly shorter than that in open group,and the difference was statistically significant(P<0.05).Postoperative VAS score and ODI score of the two groups were significantly improved compared with those before operation(P<0.05).However,at 3 days after operation,the VAS score and ODI score in the minimally invasive group were significantly lower than those in the open group(P<0.05),but there was no significant difference between the two groups in VAS score and ODI score at postoperative third months and last follow-up(P>0.05).There were 4 cases intraoperative complications in the open group,0 case in the minimally invasive group.and incidence of intraoperative complications in the open group(8.70%)was significantly higher than that in the minimally invasive group.There was a significant difference in the incidence of intraoperative complications between the two groups(P<0.05).The slippage rate of the two groups decreased significantly compared with that before operation.However,at the postoperative third day,postoperative third month and last follow-up,there was no significant difference between the two groups in the slippage rate(P>0.05).At the last follow-up,according to the Siepe intervertebral fusion evaluation criteria,the intervertebral fusion rate in the minimally invasive group was 91.30%(42/46),and the intervertebral fusion rate in the open group was 86.96%(40/46).There was no significant difference in the intervertebral fusion rate between the two groups(P>0.05).Conclusions MIS-TLIF assisted by microscopy the treatment of lumbar spondylolisthesis with spinal canal stenosis in the middle-aged and elderly people,on the basis of ensuring the basic surgical effectiveness,reduced the damage of surgery to normal spinal structure,improved the safety of operation and promoted the rapid rehabilitation of patients.It provided aneffective and safe minimally invasive operation for the treatment of lumbar spondylolisthesis with spinal canal stenosis middle-aged and elderly people.