| Objective:The purpose of this study is to explore learning curve of MIS-TLIF for physicians carried out or have carried out but has yet to pass the the technology’s learning curve to provide reference.Methods: Clinical data of 38 patients performed with MIS-TLIF by orthopedic single operation team for the treatment of lumbar degenerative disease from February to December of 2014 at Fujian Medical University Union Hospital were retrospectively analyzed.The operation were perfomed through a minimally invasive channel system,with the unilateral or bilateral vertebral canal decompression, and the cages were implanted by the unilateral intervertebral foramen. The corresponding segments were implanted screws with double sides under minimally invasive channel.Patients included of 31 cases with single-level through unilateral approach decompression, 4cases with double-levels through unilateral approach decompression, 3 cases with single-level through bilateral approach decompression.All 38 cases with corrected operation time,using the logarithmic curve-fit regression analysis to evaluate the learning curve.In the group of 31 cases with single segmental unilateral decompression, 13 patients were defined as the “early” group(among the first 15 of the series), and the subsequent 18 cases were defined as the “late” group for comparison. Perioperative indicators,including operative time,intraoperative blood loss, reoperative rates, ambulation recovery time and postoperative hospital stay were measured. When the patients were in the preoperative and postoperative 1 week, 1 month, 3 months, a visual analog pain(VAS) and the Oswestry Disability Index(ODI) were also assessed.Rssults: Differences of average age, sex, body mass index, complications and pathological changes of level in the two groups had no statistical significance(P ﹥0.05).However,the operative time was significantly longer in the early group with the median 235(32)min than in the late group with 180(16)min(P﹤0.01). Statistics also indicate that the blood loss during operation was significantly more in the early group with the median 200(250)ml than in the late group with 100(50)ml(P﹤0.05). All surgeries were performed successfully though a minimally invasive operation under the channel. No significant differences were found in ambulation recovery time and postoperative hospital stay between the two groups(P ﹥ 0.05). However, 2 cases(15.38%) in the early group needed for reoperation. The 7th case with symptom of serious pain of right lower limb,received the second ploration,found the pedicle medial bone of L5 fell into the spinal canal, oppressing the nerve root L5 on the right side.The13 th patient accepted the reoperation since no eased pain of right lower limb after the operation,the rest nuclecus pulposus was found,oppressing the nerve root L5 on the right,leading to edema. But no complications occurred in the late group.There were no complications such as postoperative cerebrospinal fluid leakage, epidural hematoma,infection of incision in both groups.All patients were followed up for 2.7 months on average in the two groups.When compared back/leg pain VAS and ODI of 1 week,1month, 3 months after operation with preoperative scores within each group, differences were statistically significant(P ﹤ 0.01).However,there was no significant difference between group the two groups(P﹥0.05).Conclusion: 1.The learning curve based on the operation time of MIS-TLIF by bilateral pedicle screws internal fixation with small incision was approximately 15 cases.After then,patients may at least bebefit from reducing operative time and intraoperative blood loss.2.The recent surgery clinical effect is satisfactory. |
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