Comparison Of Open And Minimally Invasive Transforaminal Lumbar Interbody Fusion For The Treatment Of Single-segment Lumbar Disease

[Background]In the process of surgical treatment of lumbar degenerative diseases,spinal canal decompression and interbody fusion fixation has been the focus of clinical application and research.The traditional posterior lumbar inter-body fusion has great damage to the vertebral muscle and posterior column of the vertebral body,which results in the residual lumbar and back pain after operation in some patients.In 1982 Harms and Rolinger were improved on the basis of PLIF operation to the open transforaminal lumbar interbody fusion.Open Tlif retains the integrity of the spines and ligaments,and reduces nerve root traction and dural sac injury,and these technical advantages enable the rapid extension of TLIF technology.However,there are still TLIF similar open surgery lumbar surgery problems,such as large paraspinal soft tissue injury,blood loss more.Therefore,how to improve TLIF surgery,make it become less injury,better efficacy of the technology become a research hotspot.2003,Foley ET.for the first time,the treatment of lumbar degenerative diseases by minimally invasive transforaminal lumbar interbody fusion.MIS-TLIF with the blunt separation of the posterior muscle and the pedicle screw fixation along the cleft muscle and the longest muscle gap,the large range of soft tissue and muscle avulsion were avoided theoretically.Previous studies have shown that compared with the traditional TLIF,MIS-TLIF operation,with little trauma,less bleeding and postoperative back pain etc.In the evaluation of lumbar interbody fusion,compared with X-ray examination compared with pure,CT scan can accurately observe interbody fusion,with higher accuracy.Through the retrospective analysis of two operative methods in patients with clinical data and imaging data of this study,in order to compare the two kinds of surgical treatment of lumbar degenerative disease effect.[Objective]To compare clinical efficacy of minimally invasive transforaminal lumbar interbody fusion and open transforaminal lumbar interbody fusion for the single segment retrograde degeneration lumbar spine disease,and discussion on advantages and disadvantages of MIS-TLIF operation in clinical application.[Methods]Retrospective analysis of 45 patients with single segmental lumbar degenerative disease in our department,with 27 patients in the group of open transforaminal lumbar interbody fusion,and other 18 patients in the group of minimally invasive transforaminal lumbar interbody fusion.The age,weight,surgery levels,operation time,the length of the incision,blood loss,postoperative drainage,bed time,VAS,ODI and fusion rate were compared between two groups.[Results]There was no significant differences in general date,surgery levels,operation time(146.3min±48.9min and 135.3min±50.1min),bed time(11.4d±2.2d and 11.6d±3.6d),VAS and ODI before surgery(P﹥0.05).The length of the incision,blood loss,postoperative drainage in MIS-TLIF group were 2.2cm±0.4cm、158.3ml±82.7ml、58.9ml±33.9ml,less then the 9.9cm±1.9 cm、472.2ml±350.9ml、176.9±96.6ml,of open group(P﹤0.05).MIS-TLIF group was superior to open TLIF group in back pain after surgery at 1 week and 3 months after surgery(P﹤0.05).There was no significant differences in VAS and ODI scores after 3 months between two groups.And no differences for fusion rate of the 1 year(P﹥0.05).[Conclutions]MIS-TLIF and open TLIF can achieve similar forward treatment efficiency,but MIS-TLIF is superior to open TLIF in the length of the incision,blood loss,postoperative drainage,bed time and relieve the back pain after surgery.