Comparative Study Of Unilateral And Bilateral Partial Laminectomy And Decompression MIS-TLIF In The Treatment Of Bilateral Symptomatic Degenerative Lumbar Spinal Stenosis

Objective: compare the difference between the two surgical methods of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)unilateral and bilateral decompression for the treatment of bilateral symptomatic degenerative lumbar spinal stenosis,and provide clinical data reference for choosing an appropriate surgical method to treat degenerative lumbar spinal stenosis(DLSS)with bilateral symptoms.Methods: the medical records of patients with bilateral symptomatic d-egenerative lumbar spinal stenosis from January 2019 to June 2020 in our hospital were collected,and 40 patients who met the criteria were selected for retrospective analysis.According to the operation methods,they were divided into unilateral decompression MIS-TLIF group(20 cases)and bilateral decompression MIS-TLIF group(20 cases)MIS-TLIF was performed by unilateral and bilateral laminectomy under quadrant.The general condition,operation time,intraoperative blood loss,postoperative drainage,postoperative hospital stay,height of intervertebral foramen and intervertebral space,incidence of complications and bone graft fusion rate,as well as the visual analogue scale(VAS)and oswestry disability index(ODI)of all patients preoperative,1 month after surgery and at the last follow-up.Results: the postoperative follow-up was 9～12 months,with an average of10.7 months.There was no significant difference between the two groups of patients in gender,age,preoperative intervertebral space and intervertebral foramen height,preoperative VAS and ODI(P>0.05).All patients completed the operation successfully.The average operation time of unilateral decompression MIS-TLIF group was 180.90 ± 26.02 min and 223.16 ± 36.97 min in the bilateral decompression MIS-TLIF group,and the intraoperative bleeding of unilateral decompression MIS-TLIF group was 275.00 ± 159.35 ml and 575.00±324.64 ml in bilateral decompression MIS-TLIF group,and the postoperative drainage volume was 127 ± 51.91 ml in unilateral decompression MIS-TLIF group and379.15 ± 209.50 ml in bilateral decompression MIS-TLIF group,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative hospital stay、postoperative intervertebral foramen height and intervertebral foramen height at 1 week,3 months and the last follow-up(P>0.05).One month after operation,there were significant differences in VAS and ODI between the two groups(P<0.05),and there was no significant difference in VAS and ODI between the two groups at the last follow-up(P > 0.05).However,the preoperative intervertebral foramina height,intervertebral space height,VAS and ODI of the two groups were significantly different from the postoperative comparison(P<0.05).There were no serious complications such as nerve root injury,vascular injury,loosening of internal fixation,broken screw,fusion cage sinking and formation of intraspinal hematoma in the two groups.There was one case of cerebrospinal fluid leakage one case of incision infection in the bilateral decompression MIS-TLIF group.There was no complications in the unilateral decompression MIS-TLIF.At the last follow-up,the fusion rate of bone graft was 100% in both groups,and the difference was not statistically significant.Conclusions: the clinical efficacy of unilateral partial laminectomy and decompression MIS-TLIF and bilateral partial laminectomy and decompression MIS-TLIF in the treatment of bilateral symptoms of degenerative lumbar spinal stenosis is similar,but the operation time,intraoperative blood loss and postoperative drainage of unilateral decompression MIS-TLIF group are significantly less than those of bilateral decompression MIS-TLIF group.Unilateral decompression MIS-TLIF is a safe and effective method with less injury,shorter operation time and less bleeding.