| BackgroundThe lumbar spine is the main part of supporting normal human activities,and also bears a huge weight.Under long-term pressure and friction,it becomes one of the organs that degenerate earlier and faster in human body.Degenerative lumbar spinal stenosis is a degenerative disease of the spine.The incidence rate increases with age.It is one of the main causes of lumbago and leg pain in the elderly,and it has a serious impact on the quality of life of the elderly.At present,the clinical treatment of lumbar spine lesions is mainly divided into conservative treatment and surgical treatment,for patients who do not respond to conservative treatment,surgery is the best choice.There are many surgical methods for the treatment of degenerative lumbar spinal stenosis,but there is no unified standard With the continuous development of minimally invasive technology,minimally invasive decompression has become the preferred surgical scheme for the disease.Percutaneous transforaminal endoscopic fusion and internal fixation under the channel are the representative of minimally invasive technology.However,there is still a lack of comparative study on the clinical effect of degenerative lumbar spinal stenosis,which also restricts the selection of the best minimally invasive surgical scheme for the disease.This study aims to observe the therapeutic effect of percutaneous transforaminal endoscopic lumbar interbody fusion(ELIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in patients with lumbar spinal stenosis.ObjectiveThis study compares the efficacy of percutaneous transforaminal endoscopic lumbar interbody fusion(ELIF)with minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in degenerative lumbar spinal stenosis and its impact on patients’ physiological indicators,aiming to provide clinical information.Surgical treatment of lumbar spine lesions provides a theoretical basis in order to improve the surgical process and better serve elderly patients.MethodA retrospective study was conducted to randomly select 70 patients diagnosed with degenerative lumbar spinal stenosis from January 2017 to January 2019 at the Military Hospital of the Eighty-third Group of the Chinese People’s Liberation Army(formerly Xinxiang 371 Hospital),all of whom were ineffective after conservative treatment and required surgical treatment.The patients were divided into groups according to the surgical methods.Among them,35 patients who were treated by percutaneous fixation of intervertebral foraminoscopic fusion were included as the intervertebral foraminoscopic group,and 35 patients who were treated by minimally invasive transforaminal lumbar interbody fusion were included as the MIS-TLIF group.General basic data of enrolled patients were collected,including gender,age,surgical segment(L4/5,L5/S1),height,body mass index,blood pressure,heart rate,smoking,alcohol consumption,hypertension,diabetes,conservative treatment time;The effect of two groups of surgery was determined from operation time,intraoperative bleeding volume,postoperative drainage volume,bed rest time,length of hospital stay,medical expenses,etc.The effect of different fixation and fusion techniques on patients’ inflammatory response was observed by serum inflammatory markers(CRP,ESR.),and evaluated on before operation 7 days after operation.Pain score(VAS),Japanese Orthopaedic Association score(JOA)and Oswestry Dysfunction Index(ODI)were observed and recorded before and after surgery in both groups.VAS score:Scores range from 0 to 10,ranging from no pain to the most severe pain.The pain was divided into three grades:no pain,slight pain,severe pain,0-3,4-7,>7 points;JOA score:the table included lower back pain,leg pain and/or numbness,gait,straight leg elevation test,sensory impairment,dyskinesia,bladder function and other items,with a total score of 0-29 points,the lower the score,the more significant the dysfunction.ODI score:The higher the score,the more significant the dysfunction.The above indicators were evaluated after surgery,ODI score:The higher the score,the more significant the dysfunction.The above indicators were evaluated after surgery,3 months and 6 months..The incidence of intraoperative and postoperative complications,intraoperative complications:hemorrhage,nerve injury,dural tear,surgical segment error,instrument rupture,and postoperative complications:nerve injury,infection,remnants of protrusion removal,nucleus pulposus re-protrusion,intraspinal hematoma,psoas major hematoma,endplate inflammation,postoperative lumbar instability,postoperative lumbar back pain,myofascitis,were analyzed.The total effective rate of each group was recorded.The excellent rate of long-term recovery of joint function and the occurrence of complications were compared between the two groups through follow-up investigation.ResultsThere were no significant differences between the two groups in terms of gender,age,operative segment(L4/5,L5/S1),height,body mass index,blood pressure,heart rate,smoking,alcohol consumption,hypertension,diabetes mellitus and conservative treatment time(P>0.05).The results showed that the two groups were comparable;the intraoperative bleeding volume and postoperative drainage volume in the foraminoscopy group were lower than those in the MIS-TLIF group,but the operation time in the foraminoscopy group was longer than that in the MIS-TLIF group,and the difference was statistically significant(P<0.05).The medical expenses of the intervertebral foramen group were higher than those of the MIS-TLIF group,and the difference was statistically significant(P<0.05).There were no significant differences in the length of bed rest and hospital stay between the two groups,P>0.05.There was no significant difference in ESR and CRP between the two groups before operation(P>0.05),and ESR and CRP in the intervertebral foramen group were lower than those in the MIS-TLIF group at 7 days after operation(P<0.05),and there was no significant difference in VAS scores of low back pain and leg pain between the two groups before operation(P>0.05).The VAS scores of low back pain and leg pain in the two groups decreased to different degrees at 3 and 6 months after operation,among which the VAS scores of low back pain in the intervertebral foramen group were significantly lower than those in the MIS-TLIF group,the difference was statistically significant(P<0.05),the VAS scores of leg pain in the two groups were not statistically significant(P>0.05),and there was no significant difference between the JOA scores and ODI indexes in the two groups before operation(P>0.05).The JOA score and ODI index of the two groups improved to different degrees after 3 and 6 months of operation,and the JOA score of the intervertebral foramen group was significantly higher than that of the MIS-TLIF group,with a significant difference(P<0.05);ODI index compared with MIS-TLIF group difference was not statistically significant(P>0.05).Comparing the clinical effects of the two groups of patients,we found that there was no significant difference in the effective rate between the two groups(P>0.05),but the incidence of intraoperative and postoperative complications in the intervertebral foramen group was lower than that in the MIS-TLIF group in the same period,and the difference was statistically significant(P<0.05).ConclusionThis study shows that for elderly patients with degenerative lumbar spinal stenosis,percutaneous transforaminal endoscopic lumbar interbody fusion(ELIF)can achieve similar treatment effect as MIS-TLIF operation,but ELIF can reduce blood loss,reduce low back pain,and the incidence of complications is less,which is worthy of clinical application. |
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