The Application Value Of Percutaneous Endoscopic Visualization Of Screw Placement In Endo-LIF Pedicle Screw Placement

Objective: To explore application value of percutaneous endoscopic visualization of screw placement in percutaneous endoscopic posterior lumbar interbody fusion(Endo-PLIF)pedicle screw placement.Methods: A total of 50 patients with lumbar discogenic low back pain,lumbar spinal stenosis with lumbar instability,lumbar disc herniation with lumbar instability,and lumbar spondylolisthesis(Meyerding classification I and II)with indications for lumbar fusion surgery from October 2020 to April 2021 are selected.Fifty patients are randomly divided into two groups,A and B,with25 patients in each group.The difference between two groups is the surgical approach of percutaneous pedicle screw placement.In group A,the procedure is Endo-LIF+visual pedicle screw placement under percutaneous spinal endoscopy,while in group B,the procedure is Endo-LIF+traditional percutaneous pedicle screw placement.The total number of X-ray fluoroscopies,guide wire placement time,operation time,and postoperative hospital stay are compared between two groups.The Gertzbein-Robbins criteria are used to evaluate the excellent rate of nail placement.The pre-op and post-op day VAS score and VAS score at the time of discharge,modified Mac Nab criteria and postoperative complication rate to evaluate the efficacy.Besides,improved percutaneous endoscopic nail placement device is manufactured by 3D printing and research validates its feasibility and practicality.The above mentioned indexes are used to observe X-ray radiation for doctors and patients,minimally invasive nature,excellent rate of nail placement and surgical results.Results: All patients completed the procedure,with a transit procedure of0,and the follow-up time of A group and B group is(5.44±1.50)months and(5.64± 1.89)months,respectively,with no significant difference(P> 0.05).The total frequencies of fluoroscopy in A group is 6-12,with average value of(8.76±2.01),which is less than B group’s 10-26 with average value of(20.64±4.28),P value satisfied(P<0.05).The guide wire placement time of A group is 30-62 minutes,with average duration of(38.68±7.85)min;the guide wire placement time of B group is 25-70 minutes,with average duration of(45.48±10.54)min;there are significant differences between two groups(P<0.05).The operation time of A group is 150-190 minutes,with average duration of(169.20±11.79)min;the operation time of B group is 160-195 minutes,with average duration of(176.40±11.23)min;significant differences are found(P<0.05).No significant differences are found in postoperative hospital stay in A group(4.60±1.35days)compared with B group(5.00±1.08days)(P>0.05).A total of 200 pedicle screws are placed in two groups,of which the excellent rate of nail placement is 95% in A group and 84% in B group.Comparing two groups,the excellent rate of percutaneous endoscopic nail placement in A group is better than B group(P<0.05).The preoperative VAS(7.56 ± 0.82)in A group and VAS(7.52±0.59)in B group are not significantly different(P>0.05);VAS in group A(4.28±0.94)and group B(4.56±1.08)on the postoperative day,and there is no significant difference in VAS scores compared to the two groups on the postoperative day(P>0.05).At discharge,VAS in group A(2.24±0.60)and VAS in group B(2.40±0.82),there is no significant difference in VAS scores compared to the two groups at discharge(P>0.05).However,VAS scores improve in both groups one day after surgery and at discharge compared to preoperative(P<0.05).At the final follow-up,the excellent rates of modified Mac Nab criteria of A group and B group reach 96% and 92% respectively with no significant difference(P>0.05).There is one case of postoperative nerve root numbness aggravation in A group without other complications and no complications in B group.Their incidence is 4% and 0%,no significant differences are found(P>0.05).Conclusion: The results of both minimally invasive surgical approaches are good.Percutaneous endoscopic visualization of screw placement reduce the number of X-ray and radiation exposure risk for doctors and patients,and improve the excellent rate of nail placement.Meanwhile,the 3D-printed percutaneous endoscopic screw placement instruments have feasibility and practicality.In conclusion,this study has potential clinical application value.