Analysis Of Clinical Outcomes Between PLIF And MIS-TLIF In Elderly Patients With Lumbar Degenerative Disease

Background:According to world demographics,the number of elder people over 65 years of age can reach 600 million,and will be expected to exceed 700 million by 2020.The global population is aging,the number of elderly patient increased accordingly.Age and pathological change will reduce the elastin content of the posterior longitudinal ligament,strength of trunk and back muscles,spinal bone density which can lead to rupture of annulus fibrosus,nucleus pulposus prolapse,loss of intervertebral height,hypertrophy of ligamentum flavum and intervertebral joint.Lumbar degeneration increase incidence of degenerative lumbar degeneration,resulting in lower back and legs pain and trunk dysfunction,which can affect the quality of life patients.At present,the surgical treatment of lumbar degenerative disease is diversified.Lumbar interbody fusion considered as an effective surgical treatment of lumbar degenerative disease,can effectively relieve symptoms,restore the physiological sequence of the spine,improve stability,shorten bedridden time and hospital stays.In recent years,minimally invasive and intelligent surgical technology has been developing.In the field of spine surgery,minimally invasive technology,especially MIS-TLIF,has been rapid development with new technologies emerging and wilder clinical indication.Although the elderly population who have basic diseases and poor average physical quality have higher perioperative risk of spinal surgery,some scholars advocate old patients over 70 years or 80 years with intervertebral fusion surgery is considerable and surgical safety is high.This study aims to compare the efficacy of PLIF and MIS-TLIF in patients with degenerative lumbar degeneration over 75 years of age to provide clinical guidance for surgical treatment of elderly patients in the future.Object:To evaluate the clinical effect between minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)under Quadrant expandable access system and posterior lumbar interbody fusion(PLIF)for single level lumbar degenerative disc disease in the patients over 75 years.Methods:From January 2013 to January 2016,clinical data about 48 eligible cases over 75 years with single level lumbar degenerative disc disease treated by the same medical team of our hospital were retrospectively analyzed,including 29 cases males and 19 females.The mean age of the patients was 76.9 years,and mean course of disease is 64.7 months.19 cases of lumbar disc herniation,21 cases of lumbar spinal stenosis and 8 cases of lumbar spondylolisthesis with II degree,diagnosed by combing clinical symptoms,physical examination and imaging tests,such as lumbar X-ray film,flexion-extension radiographs,computed tomography and magnetic resonance imaging.There are 22 cases underwent MIS-TLIF treatment under Quadrant expandable access system,and 26 cases were treated by PLIF.The perioperative characteristics,such as: age,gender,clinical course,surgical level,the number of comorbidities,preoperative back and leg pain Visual Analogue Scores(VAS)and Japanese Orthopaedic Association Scores(JOA)were no statistically significant difference between the two groups(P<0.05).Perioperative characteristics(operative blood less,post-operation drainage,shorten bedridden time and hospital stays),clinical effect(back,leg VAS score and lumbar JOA score)and the incidence of complications of two groups were compared and the clinical outcomes of the two surgical methods for the elderly patients were also analyzed.Results:Two groups' patients all have significant improved in back and leg Visual Analogue Scores and ODI after operation(P<0.05).MIS-TLIF group owns statistical significant advantage on back VAS score at 3days and 3 months,however,there are no significant differences at the final follow-up between 2 groups(P>0.05).There were less operative blood less,post-operation drainage,shorten bedridden time and hospital stays,milder postoperative short term back pain in MIS-TLIF group than in PLIF group,but the operation time is longer in MIS-TLIF group(P<0.05).The postoperative complication rate in MIS-TLIF group and PLIF group was 9.1% and 23.1%,without statistical significance(P>0.05).Conclusions:MIS-TLIF and PLIF both have satisfied curative outcomes for the elderly patient older than 75 years,and they can achieve the same clinical efficacy.Compared with PLIF,MIS-TLIF has advantages of less perioperative blood less,shorten bedridden time,hospital stays,milder postoperative short term back pain,quick recovery,especially for elderly groups.