Comparison Of Clinical Efficacy Between MED-TLIF And Wiltse Surgical Approach TLIF In Treatment Of Lumbar Degenerative Diseases

Background: Lumbar degenerative disease is a disease that occurs during the process of natural aging and degeneration of lumbar vertebra.With the gradual progress of the normal physiological degeneration process of human body,it often leads to the occurrence of spondylolisthesis,lumbar disc herniation,lumbar spinal stenosis and rachioscoliosis.When conservative treatment can not completely solve the symptoms of lumbago and leg pain,surgical treatment provides a more reliable means.The traditional posterior approach of lumbar interbody fusion need to dissect the large range of paravertebral tissue,which will injury the muscle,blood vessels and nerves around,and result in paravertebral muscle degeneration and scar formation.There may be lead to long-term postoperative back pain and discomfort,and effect the functional recovery.Transforaminal lumbar interbody fusion(TLIF)proposed by Hams in 1982 can decrease the damage to normal tissue,get better nerve decompression and postoperative effect which is compared with traditional posterior open surgery,and widely used in clinic.In 1988 Wiltse and Spencer et al.proposed the Wiltse approach that through the clearance of multifidus and longissimus,which can be used to solve the injury of paraspinal muscles by open surgery.In order to further improve the damage caused by surgery,minimally invasive spine surgery technology has been developed,and achieved good clinical results.Transforaminal lumbar interbody fusion via Micro Endo Disc System(MED-TLIF)is currently one of the main minimally invasive surgery in treatment of lumbar degenerative disease,compared with the traditional surgery,has many advantages,but there are still few studies confirmed the clinical effect.Objective: To compare the clinical efficacy of MED-TLIF and Wiltse surgical approach TLIF in the treatment of lumbar degenerative disease.Methods:Retrospective analysis of the 37 patients with lumbar degenerative disease which were enrolled in our hospital from December 2015 to December 2016.There were 19 cases of male and 18 cases of female,aged from 31 to 78 years,with an average age of 56.8 years;duration of 6 months ~ 10 years,with an average of 22.6 months.15 cases in MED group underwent Transforaminal lumbar interbody fusion via Micro Endo Disc System(MED-TLIF),22 cases in Wiltse group underwent Wiltse surgical approach TLIF(Wiltse-TLIF).Comparison of two groups of patients with the age,duration of disease,osteoporosis index(beta-Crosslaps,osteocalcin,25-(OH)vitamin D3),length of surgical incision,operation time,blood loss,the time of ambulation,hospital stay after surgery,treatment cost,and evaluate their clinical efficacy with the visual analogue scale(VAS)and Japanese Orthopedic Association score JOA),Oswestry disability index(ODI)and the MOS item short from health survey(SF-36).Results:37 patients were followed up for 3~12 months,average 6 months.There were no significant differences found in the age,gender,course of disease and osteoporosis index between two groups.MED group was shorter than Wiltse group in the length of incision(3.12±0.56 cm vs 10.21±1.13cm),postoperative bed time(6.1±1.21 ? vs 7.2±1.32days)and days of the hospital stay after surgery(10.12±1.28 vs 12.82±1.48 days)and the difference was statistically significant(P < 0.05);Wiltse group is shorter than MED group in Operation time(302.27±55.94 VS 218.81±41.69)min,MED group's treatment cost is more than that in group Wiltse(70050.40±20367.68 vs 60407.72±10537.94)yuan,the difference was statistically significant(P< 0.05);Bleeding volume of MED group was slightly less than that of Wiltse group(203.91±189.28 vs 334.37±160.97)ml,the difference was not statistically significant(P > 0.05).The patients' VAS,JOA,ODI,SF-36 scores were significantly improved at 1 weeks,1 months,3 months for two group,the difference was statistically significant(P<0.05),but was similar between the two groups,the difference was not statistically significant(P>0.05),it shows that the two kinds of surgical treatment all with obvious clinical effect,but the short-term clinical effects of two groups were similar with no significant difference.Conclusion:MED-TLIF and Wiltse-TILF are effective in treatment of lumbar degenerative disease,but MED-TLIF surgery has the advantages of minimally invasive,high curative effect,safety,low complication,which can achieve early functional exercise,recover daily life and improve the quality of life.But there need a larger sample size and longer follow-up time study to confirm the clinical effect.