The Clinical And Applied Anatomy Study Of Interbody Fusion By Microendoscopic For Degenerative Lumbar Instability

Objective To study the clinical technique and effect of decompression and interbody fusion by Microendoscopic and the operation-related anatomical structures was observed to provide anatomical basis for clinical applications. Methods 48 patients with degenerative lumbar instability syndrome were treated by Microendoscopic,during which the decompres-sion by vertebral plate space approach and the interbody fusion by intervertebral foramina ap-proach were performed. The clinical outcomes were assessed by Macnab criteria:Excellent: No pain; no restriction of activity. Good:Occasional back or leg pain of sufficient severity to interfere with the patient's ability to do his normal work or his capacity to enjoy himself in his leisure hours. Fair:Improved functional capacity, but handicapped by intermittent pain of sufficient severity to curtail or modify work or leisure activities. Poor:No improvement or insufficient improvement to enable increase in activities. At the same time the clinical out-comes were assessed by visual analog scale (VAS) scores and Oswestry Disability Index (ODI) scores and the result of interbody fusion was estimated by X-ray according to Bran-tigan criteria. Local operation-related anatomical landmarks and other anatomical structures of adult lumbar spine in 10 fresh frozen adult cadavers specimens was observsed and mea-sured. Results All the cases were finished successfully and were followed up for a period of 6-18 months(means 12 months). The operative time was 70～150 minutes(means 95 min-utes), and the blood loss was 110～210ml(means 150 ml). No complication occurred. The clinical outcomes were assessed by Macnab criteria.24 cases was excellent,20 cases was good and 4 cases was fair. The VAS and ODI scores show statistically significant improve-ments (p<0.01). The X-ray show that interbody fusion happaned at 6 months after the operation in 17casas and 31 casas at 9 monthes after the surgery. The TAP (Meet point of Superior articular process and transverse process)et al is a useful anatomical landmarks in the lumbar foraminal region and can provide the distance and distribution trends parameters for the operation. Conclusion The technique of decompression and fusion under Microendo-scopic can provide a minimally invasive and satisfactory treatment result for degenerative lumbar instability syndrome. The HP TAP et al are meaningful and persistent anatomical landmarks in lumbar foraminal region. Taking it as reference could help to successfully im-prove safety and reduce injury.