Comparative Study On The Treatment Of Lumbar Spinal Stenosis Through Traditional PLIF Surgery And Bilateral Decompression Via Unilateral Approach Of MIS-TLIF Under The Channel

Object:This paper aims to make a comparison of the clinical effects in treating lumber spinal stenosis through bilateral decompression via unilateral approach of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)under Quadrant channel and through traditional posterior lumbar interbody fusion(PLIF)surgery.Methods:A retrospective study was conducted on 51 patients with lumbar spinal stenosis who underwent single-segment lumbar intervertebral fusion and internal fixation in the same medical group of the department of spinal surgery,China-Japan Union Hospital,Jilin University from September 2016 to March 2018.According to the operative procedures,they were divided into MIS-TLIF group and PLIF group.In the MIS-TLIF group,bilateral decompression surgery was performed via unilateral approach of MIS-TLIF under the Quadrant channel on a total of 26 patients,including 15 males and 11 females,with an average age of 63.19 years old.PLIF surgery was performed in the PLIF group on a total of 25 patients,including 11 male patients and 14 female patients,whose average age is 65.24 years old.There were no statistical difference(P<0.05)in age,gender,course of disease,surgical segment distribution,preoperative Visual Analogue Score(VAS)of lumbar and leg pain and preoperative Japanese Orthopaedic Association(JOA)Scores of lumbar spine between the two groups.PLIF group and MIS-TLIF group were compared in terms of clinical efficacy(VAS score and JOA score of lumbar and leg pain at 3 days,3 months and 12 months after surgery),perioperative indicators(operation time,intraoperative blood loss,postoperative drainage volume,postoperative bed rest time,postoperative hospital stay,complication rate),and intervertebral fusion rate;The differences in the sagittal diameters of the spinal canal in the plane of the operative segment on the lumbar CT before and 3 days after surgery in the MIS-TLIF group were compared.Results:VAS score and JOA score of lumbar spine pain in the two groups were significantly improved after surgery compared with those before surgery,and the difference was statistically significant(P<0.05);The VAS score of lumbago 3 days and 3 months after surgery in MIS-TLIF group was lower than that in PLIF group(P<0.05);There was no statistically significant difference in the VAS score of lumbago between the two groups 12 months after surgery(P>0.05),nor statistical difference in VAS score of leg pain and JOA score of lumbar spine between the two groups at each time point of follow-up(P>0.05).The intraoperative blood loss,postoperative drainage volume,postoperative bed rest time and postoperative hospital stay in the MIS-TLIF group were all lower than those in the PLIF group(P<0.05),but the operative time in MIS-TLIF group was longer(P<0.05);There was no significant difference in postoperative complication rate and intervertebral fusion rate between the two groups(P>0.05);In MIS-TLIF group,the sagittal diameter of the spinal canal in the plane of the operative segment increased compared with that before surgery,and the difference was statistically significant(P<0.05).Conclusions:Traditional PLIF surgery and bilateral decompression via unilateral approach of MIS-TLIF under the channel can both achieve good clinical effect in the treatment of lumbar spinal stenosis.Compared with the traditional PLIF surgery,the bilateral decompression surgery via unilateral approach of MIS-TLIF under the channel has the advantages of less damage to the paravertebral muscle and the bone-ligament complex behind the spine,less bleeding,shorter bed rest and hospital stay,and less short-term postoperative low back pain.