| Objective: Through the comparative study of minimally invasive and open surgery,the accuracy and safety of pedicle screw implantation in minimally invasive transforaminal lumbar vertebral body fusion were discussed,and the relevant influencing factors and clinical efficacy were analyzed and summarized..Methods: This study retrospectively analyzed 101 patients who underwent posterior lumbarapproach via intervertebral foraminal fusion in the department of spine surgery of Qingdaomunicipal hospital due to degenerative lumbar diseases from June 2016 to December 2018 The patients were divided into two groups according to their surgical procedure.Minimallyinvasive transforaminal lumbar interbody fusion: 49 cases;Open surgery group: 52 cases.Allpatients underwent preoperative X-ray,CT and MRI examinations.Intraoperative operationtime and intraoperative blood loss of patients in the two groups were recorded,andpostoperative X-ray and three-dimensional CT examination of lumbar spine were performed.According to postoperative three-dimensional CT axial images of lumbar spine,pedicle screwpositions were graded according to Gertzbein classification.Class 0: screws completelylocated within the pedicle;Class l: screws that penetrate the bone wall of the pedicle but <2mmLevel 2: screws that penetrate the pedicle wall between 2-4mm;Level 3: screws that penetratethe bone wall of the pedicle and > 4mm.Complete implantation of the screw without breakingthrough the pedicle wall is called TC screw.Lateral screw angle(TSA angle)of axial CT wasmeasured at the same time.The direction of screw displacement,severity of cortical punctureneurovascular injury,TSA Angle,operation time,intraoperative blood transfusion volumeVAS and ODI scores at different time before and after surgery were compared between thetwo groups.Results: In the minimally invasive group,49 cases were enrolled,and a total of 202 screws were implanted,with an average of 4.1 screws per case.A total of 202 screws were placed in the segment l3-s1.157(77.72%)screws of them were completely placed screws,that is,the screws were completely located in the pedicle cortex(level 0).45 screws(22.28%)were in poor position.Among them,,there were 25 level 1 screws(12.38%),14 level 2 screws(6.93%)and 6 level 3 screws(2.97%).Of the 45 poorly positioned screws,10(4.95%)penetrated the medial wall of the pedicle,23(11.39%)penetrated the lateral wall of the pedicle,and 12(5.94%)penetrated the anterior wall of the pedicle.Ten screws penetrated the medial wall of the pedicle,four of which were level 1,four of which were level 2,and two of which were level 3.Of the 23 screws that penetrated the lateral wall of the pedicle,13 were level 1,6 were level 2,and 4 were level 3.Of the 12 screws penetrating the anterior lateral wall of the pedicle,8 were level 1,4 were level 2,and no level 3 screws were found.No postoperative neurological symptoms or vascular injuries were found.In the open surgery group,52 cases were enrolled,and a total of 254 screws were implanted,with an average of 4.8 screws/case.The nailed segments were L3-S1 segments,and a total of 254 screws are implanted,where 218(85.83%)were fully implanted screws,i.e.the screws were completely located inside the pedicle cortex(Grade 0).Thirty-six screws were in poor position.Among them,there were 23 Grade l screws(9.05%);10 Grade 2 screws(3.94%);and 3 Grade 3 screws(1.18%).Of the 36 poorly positioned screws,8(3.15%)penetrated the medial wall of the pedicle,18(7.08%)penetrated the lateral wall of the pedicle,and 10(3.94%)penetrated the anterior wall of the pedicle.Eight screws penetrated the medial wall of the pedicle,6 of which were level 1,1 of which was level 2,and 1 of which was level 3.Of the 18 screws that penetrated the lateral wall of the pedicle,11 were level 1,5 were level 2,and 2 were level 3.Ten screws penetrated the anterior lateral wall of the pedicle,6 of which were level 1,4 of which were level 2,and none of which were level 3.No postoperative neurological symptoms or vascular injuries were found.Chi-square test was performed between the minimally invasive group and the open group,and ?2=5.059,P < 0.05.There was a statistical difference between the accuracy of lumbar pedicle screw placement and the surgical method between the two groups.The accuracy of open surgery was higher than that of minimally invasive surgery.In the comparison of the same vertebral body,P values were all greater than 0.05,and there was no significant statistical difference between the two groups.Statistical analysis was performed on the surgical method and screw penetration direction of the two groups,?2=0.014,P> 0.05,and no significant difference was found between the two groups.After t test,p values of L3,L4 and L5 groups were all greater than 0.05.There was no obvious abnormality of TSA in L3,L4 and L5 groups.Among the screws in group S1,there was a significant difference in TSA between the two groups with P < 0.05 after t test.The operation time of single-segment patients in the minimally invasive group was 135-270 min.The operation time of single-segment patients in the open group was 150-220 min.There was no significant difference in operation time between the two groups(t=1.301,P > 0.05).The operation time of multi-segment patients in the minimally invasive group was 220-240 min.The operation time of multi-segment patients in the open group was 210-290 min.There was no significant difference in the operation time between the two groups(t=1.863,P>0.05).The blood loss of single-segment patients in the minimally invasive group was 100-500 ml.In the open group,the blood loss was 170-290 ml.There was a significant difference between the two groups(t=3.153,P < 0.05).The blood loss of two-segments patients in the minimally invasive group was 250-260 ml.In the open group,the blood loss was 280-600 ml.There was a significant difference between the two groups(t=2.714,P< 0.05).VAS scores of patients in the minimally invasive group and the open group were compared at 1 week,1 month and 3 months after surgery,and the differences were statistically significant(P < 0.05).At the last follow-up,the difference was not statistically significant(P > 0.05).Postoperative ODI scores of the minimally invasive group and the open group were statistically significant at 1 week,1 month and 3 months after surgery(P < 0.05).At the last follow-up,the difference was not statistically significant(P > 0.05).Conclusion: Compared with traditional open surgery,minimally invasive lumbar fusion for the treatment of degenerative diseases of the lumbar spine can achieve similar clinical efficacy and significantly reduce intraoperative blood loss.VAS and ODI scores were lower in the short postoperative period.The accuracy of pedicle screw placement in this kind of surgery is higher,but slightly lower than that of open surgery.Minimally invasive lumbar fusion is a feasible surgical method for the treatment of degenerative diseases of the lumbar spine... |
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