Application Study Of Multifidus Approach For The Surgery Of Lumbar Spondylolisthesis

Objective: Comparison the perioperative clinical curative effect and image indexbetween the multifidus muscle gap surgery group and traditional surgery group. Toevaluate the feasibility and effectiveness through the multifidus muscle gap approachSurgical treatment of the various lumbar spondylolisthesis.Methods:1Retrospective analysis March2009to October2012,140patientswho underwent surgical treatment of lumbar olisthe disease patients,70patients withlumbar spine surgery, Adopted by the multifidus muscle gap approach.23cases ofmale,47cases of female, Age34to66years old, average54.13±6.85years old,divided into group A,A1（32case）:Mild-to-moderate slip (I, II). A2（29case）：Mergeadjacent segment degeneration of mild-to-moderate slip (I, II). A3（9case）：severeslip(III, IV).70patients with lumbar spine surgery, Adopted by the traditionalsurgery approach.28cases of male,42cases of female, Age30to60years old,average50.25±5.60years old, divided into group B,B1（36case）:Mild-to-moderateslip (I, II). B2（26case）：Merge adjacent segment degeneration of mild-to-moderateslip (I, II). B3（8case）：severe slip(III, IV). Respectively compare two differentsurgical approach (A1and B1,A2and B2, A3and B3):1、perioperative indicators:The average operation time, The skin incision length, The less blood loss, The postoperative drainage,2、 The clinical curative effect:①Score; Oswestry disabilityindex(ODI) and Visual Analogue Scores(VAS). Preoperative、postoperative1weekand12months follow-up after the waist pain, leg pain and nerve function scorecomparison.②Preoperative and postoperative imaging index changes：the slippingangle，intervertebral disc height，Taillard index and fusion rate.(adopting thin layerCT reconstruction evaluating of lumbar intervertebral fusion).Result: The multifidus muscle gap surgery groups A1group：average operationtime of102.93±6.42min, The less blood loss average115.00±19.48mL，The skinincision length5.04±0.71cm，The post operative drainage74.63±13.52ml. A2group：average operation time of105.23±10.20min, The less blood loss average120.50±15.27mL，The skin incision length5.10±0.65cm，The post operativedrainage87.17±12.07ml. A3group：average operation time of109.60±11.19min,The less blood loss average161.00±11.25mL，The skin incision length6.45±0.33 cm，The post operative drainage112.80±11.48ml.compare with the traditionalsurgery groups B1group：average operation time of142.63±15.54min, The lessblood loss average271.50±28.68mL，The skin incision length6.44±0.47cm, Thepost operative drainage163.67±17.14ml.B2group：average operation time of158.80±16.44min, The less blood loss average294.00±22.80mL，The skin incisionlength8.18±0.77cm, The post operative drainage188.77±16.04ml. B3group：average operation time of185.70±13.59min, The less blood loss average377.50±49.51mL，The skin incision length10.41±0.89cm, The post operativedrainage284.50±47.64ml. significantly reduced (small), Respectively compare（A1and B1、A2and B2、A3and B3）have significant difference (P<0.05), Each group inthe slipping angle，Taillard index、the fusion rate and on the recovery of theintervertebral disc height，results very close, respectively compare（A1and B1、A2and B2、A3and B3）had no significant difference (P>0.05). Followed up for6~12months, patients with lumbar olisthe anatomy or approximate anatomy of the reset,most of preoperative symptoms disappear,a week of postoperatively by the multifidusmuscle gap surgery groups(A1、A2、A3) Lumbocrural pain VAS score lower than thetraditional surgery approach（B1、B2、B3）more obvious (P<0.05). Postoperative12months follow-up Lumbocrural pain VAS score is similar between the（A1and B1、A2and B2、A3and B3）was no statistical significance (P>0.05); ODI scorerespectively compared in the（A1and B1、A2and B2、A3and B3）was no significantdifference (P>0.05). The last follow-up by the multifidus muscle gap surgery groupsof intervertebral fusion rate was A1group：95.7%,A2group：94.3%,A3group：97.1%,and by the traditional surgery approach groups of intervertebral fusion rate wasB1group：94.3%,B2group：93.9%,B3group：98.6%. Respectively compare（A1andB1、A2and B2、A3and B3） was no significant difference (P>0.05).Conclusion:1、By the multifidus muscle gap surgery groups treatment onlumbar olisthe disease have less blood loss、small incision、less tissue damage、nervous tissue less disturbance clinical curative effect is good.2、By the multifidus muscle gap tyra reset、unilateraldecompression、bone graft and internal fixation forⅠ,Ⅱlumbar olisthe disease curativeeffect is satisfied, For lumbar olisthe disease Ⅲ degrees or more appropriate for bilateral decompression, tyra reduction, bone graft and internal fixation is more.reliable.