The Outcomes Of Single Level Minimal Invasive Versus Open Transforaminal Lumbar Interbody Fusion For Lumbar Spine Degenerative Diseases

Objective To analysize the clinical outcomes of the minimal invasive transforminal lumbar interbody fusion(MIS-TLIF)versus open transforaminal lumbar interbody fusion(Open-TLIF)in treating lumbar degenerative diseases.Methods From July 2013 to October 2015,a total of 190 patients with lumbar degenerative diseases treated with signal level spinal surgery in our department were retrospectively analyzed,105 patients received MIS-TLIF operation(MIS-TLIF group)and 85 patients received open TLIF operation(Open-TLIF group).Comparison of two groups patients with baseline data(gender,age,weight,height,disease types,duty level,complications,illness duration),various index of perioperative(operation time,intraoperative blood loss,postoperative drainage,times and length of fluoroscopy,off-bed time,duration of hospitalization)and postoperative follow-up index,VAS(visual analogue scores),ODI(Oswestry disability index),SF-36(the MOS item short from health survey)table and MacNab were used to assess the outcomes of two groups patients.Besides,the intervertebral fusion was evaluated based on Bridwell criteria and the changes of intervertebral disc height according to X-ray and CT examination.Results There was no significant difference in gender,age,weight,BMI,illness duration disease types and duty level between the two groups(P> 0.05)but the height between the two groups was statistically significant(P< 0.05).The intraoperative blood loss,postoperative drainage,off-bed time and duration of hospitalization of MIS-TLIF group were less than Open-TLIF group,and the difference among the intraoperative blood loss,postoperative drainage and off-bed time were statistically significant between two groups(P< 0.05).The operation time,fluoroscopy time and duration of MIS-TLIF group were longer than Open-TLIF group and the difference between the two groups was statistically significant(P< 0.05).Besides,MIS-TLIF group patients were divided into two subgroups according operation time.Compared with the earlier subgroup patients,the operation time,fluoroscopy time and duration in later subgroup were shorter,and the difference was statistically significant(P< 0.05).Based on VAS,there were significant changes between the two groups of patients with postoperative follow-up lumbocrural pain at one month and three months postoperation(P< 0.05),two groups of patients with postoperative follow-up low back pain VAS score of two groups were statistically significant compared with that of preoperative(P< 0.05).According to ODI scale,the difference of ODI score at one month and three months after surgery between the two groups was statistically significance(P< 0.05),the postoperation ODI score of two groups were statistically significant compared with the preoperative(P< 0.05).There was no difference in the preoperative and postoperative follow-up SF-36 score between the two groups(P> 0.05),there was no difference at one month,three months,six months and last follow-up postoperation SF-36 score between the two groups(P> 0.05).The postoperation SF-36 scores of two groups compared with the preoperative were statistically significant(P< 0.05).Based on Bridwell criteria,intervertebral fusion was evaluated in MIS-TLIF group,I level was 82 cases(78.10%),II level was 23 cases(21.90%).In Open-TLIF group,I level was 57 cases(67.06%),II level was 28 cases(32.94%),there was no significant difference between two group(P> 0.05).The postoperation intervertebral disc height of two groups were no statistically significant(P> 0.05)compared with the preoperative.The differences of two group intervertebral disc height were no statistically significant at any time points after surgery as well(P> 0.05).Conclusion Signal level MIS-TLIF and Open-TLIF surgery both could achieve positive clinical outcomes in the treatment of lumbar degenerative diseases,but MIS-TLIF compared with Open-TLIF was better in terms of less intraoperative blood loss,less postoperative drainage and off-bed time.MIS-TLIF surgery dose have an advantages in iatrogenic damage in treating lumbar degenerative diseases compared to Open-TLIF.