Minimally Invasive Unilateral Approach With Bilateral Decompression By Tubular System For The Bilateral Lumbar Lateral Recess Stenosis

Objective:To estimate advantages of minimally invasive unilateral approach with bilateral decompression by tubular system combined with interbody fusion and percutanoeus pedicle screw fixation compared with conventional bilateral transforaminal lumbar interbody fusion with pedicle screw fixation for single level bilateral lumbar lateral recess stenosis combined with interbody instability.Methods:From September 2014 to September 2016,retrospective analysing 75 patients with single level bilateral lumbar lateral recess stenosis combined with interbody instability at orthopedic department in Shanxi DAYI hospital who were treated by surgery,including 35 patients in minimally invasive group treated by minimally invasive unilateral approach with bilateral decompression by tubular system combined with interbody fusion and percutanoeus pedicle screw fixation and 40 patients in open group treated by conventional bilateral transforaminal lumbar interbody fusion with pedicle screw fixation.The blood loss,operation time,postoperative hospital stay,low back VAS scale before and after operation(1 week,3 and 6 month),JOA scale and ODI before and after operation(3 and 6month)were recorded to estimate the result between two groups.Results:The operation time of minimally invasive and open group were(134.3±8.7)ml(134.9± 8.9)ml individually and blood lossing were(108.7 ± 13.6)ml and(336.3 ± 30.0)ml individually.There was no stasitical difference of operation time between minimally invasive group and open group(P>0.05),but compared with open group,minimally invasive group own its advantage on the blood lossing(P<0.05).The postoperative hospital stay of minimally invasive group and open group were(7.8±1.0)d?(14.1±1.3)d,it hasthe stasitical difference(P<0.05).There was no stasitical difference of preoperative lumbar JOA scale,low back pain VAS and ODI between minimally invasive group and open group(P>0.05),but lumbar JOA scale in each group of every period time had rised in comparison with the preoperative(P<0.05)and low back pain VAS in each group of every period time had declined in comparison with the preoperative(P<0.05).The low back pain VAS of minimally invasive group was lower than open group at postoperative 1 week and3 month(P<0.05),but had no stasitical difference at 6 month(P>0.05).The lumbar JOA scale and ODI of minimally invasive group had stasitical difference which was in comparison with open group at postoperative 3 month(P<0.05),but there was no stasitical difference at postoperative 6 month(P>0.05).Conclusion:Compared with the conventional conventional bilateral transforaminal lumbar interbody fusion with pedicle screw fixation,the minimally invasive unilateral approach with bilateral decompression by tubular system combined with interbody fusion and percutanoeus pedicle screw fixation has the same effectiveness for bilateral lumbar lateral recess combined with interbody instability and owns its merits of less invasive and early removing which avails early recovery especially.