Assessment Of The Learning Curve Of Full Endoscopic Posterior Lumbar Interbody Fusion And Comparative Study Of Clinical Outcomes Between Full Endoscopic Posterior Lumbar Interbody Fusion And Mini-open Posterior Lumbar Interbody Fusion For Lumbar Degenerat

Objective: The purpose of this study is to explore learning curve of full endoscopic minimally invasive posterior lumbar interbody fusion.Methods: Clinical data of 50 patients performed with FE-PLIF by spine surgery single operation team for the treatment of lumbar degenerative disease from January of 2014 to May of 2016 at First Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed.All 50 cases with corrected operation time,using the logarithmic curve-fit regression were analyzed to evaluate the learning curve.All cases were divided into learning group and experienced group which were judged by the sequence before or after the turning point of learning curve.The operation time,blood loss,perioperative complications,time to mobilize,length of hospital stay,postoperative VAS and JOA scores were compared between the two groups.At 12 month,Nakai improvement rate and interbody fusion rate were evaluated.Results: All patients in the two groups were followed up for an average of 14.3±3.6 months.Differences of average age,sex,complications and segmental pathological changes of level in the two groups were not of statistically significance(P>0.05).However,the operative time of 219.3±38.2min was significantly longer in the learning group than that of 174.3±28.8min in the experienced group(P<0.05).The results of statistics also indicated that the blood loss during operation was significantly more in the learning group with 235.5±92.8ml than in the experienced group with 180.8±86.5ml(P<0.05).No significant differences were found in time to mobilize and hospital stay between the two groups(P>0.05).When comparing scores of VAS and JOA at 3 months and last follow-up after operation,with preoperative scores of each group,differences were statistically significant(P<0.05).However,there was no significant difference between the two groups(P>0.05).Nakai improvement rate and interbody fusion rate at one year after surgery were 90.9% and 55.0% in the learning group,and 91.2% and 56.7% in the experienced group,respectively.But there were no statistical differences too between the two groups(P>0.05).3 cases(6.0%)with symptom of serious pain of lower limb needed for reoperation.The NO.9 case,received an exploration surgery,hematoma formed in the gelatin sponge and the nerve root was compressed were found.Breach of the medial wall of the right pedicle of L5 occurred in cases of NO.36.The patient of NO.42 needed a reoperation because of the graft bone chips was found in the canal,oppressing the right nerve root L5.There were no other complication s such as postoperative cerebral spinal fluid leakage,epidural hematoma,infection of incision in both groups.Conclusions: 1.The learning curve based on the operation time of FE-PLIF was approximately 15 cases.After inflection point,patients may at least benefit from reducing operative time and intraoperative blood loss.2.The short-term clinical of the surgery is satisfactory.Objectives: To compare clinical outcomes between full endoscopic posterior lumbar interbody fusion and mini-open posterior lumbar interbody fusion for degenerative lumbar disease.Methods: From May 2014 to June 2016,83 patients with single-level lumbar degenerative disease underwent MIS-PLIF were enrolled in this study.All cases were divided into two groups according to the surgical methods,there were 42 cases in the FE-PLIF group,and 41 cases in the MO-PLIF.There were no significant differences preoperatively in age,gender,clinical diagnosis,lesion level,VAS and JOA scores between the two groups(P>0.05).The operation time,blood loss,intraoperative radiological exposure times,surgical incision lengths,perioperative complications,time to mobilize,length of hospital stay,postoperative VAS and JOA scores were compared between the two groups.At 12 month after surgery,Nakai improvement rate and interbody fusion rate were evaluated.Results: Operation time,blood loss,intraoperative radiological exposure times,surgical incision lengths,perioperative complications,time to mobilize,length of hospital stay in the FE-PLIF group were 135.9±18.1min?210.6±88.5ml?14±6times?3.1±0.5cm? 2.1±0.5days?9.8±1.1days;and 112.5±20.2min? 229.6±84.5ml?11±8times?4.8±0.7cm? 2.6±0.7days? 9.6±1.3days in MO-PLIF.Surgical incision lengths in the FE-PLIF group was significantly shorter in the MO-PLIF group;intraoperative blood loss in the FE-PLIF group was significantly less than MO-PLIF group.There were no statistical differences between the two groups in operation time,blood loss,intraoperative radiological exposure times,perioperative complications,time to mobilize,length of hospital stay,postoperative VAS and JOA scores.There were no statistical differences between two groups regarding to VAS and JOA scores at 1 month and the last follow-up postoperatively.Nakai improvement rate and the fusion rate at one year after surgery were 92.9% and 52.3% in the FE-PLIF,and 91.2% and 58.5% in the MO-PLIF,respectively,there were no statistical differences too between the two groups(P>0.05).Nerve root irritations by hematoma occurred in two patients,one in the FE-PLIF group and the other in MO-PLIF group;No other complications such as tear of dural matter,cerebrospinal fluid leakage,pedicle screw loosening and surgical site infection had happened.Conclusions: Both operative methods are effective in the treatment for single level lumbar degenerative diseases.The surgical incision lengths is shorter in the FE-PLIF group and,while the learning curve shorter in the MO-PLIF group.