Clinical Effect Of Minimally Invasive Transforaminal Lumbar Interbody Fusion In Elderly Patients With Degenerative Lumbar Disease Complicated With Osteoporosis

Objective: The problem of global aging is becoming more and more prominent.Especi-ally in China,the aging of the population has been accompanied by the 21 st century.Since 2000,China has entered an aging society in advance.It is currently the country with the largest number of elderly people in the world,accounting for more than one-fifth of the total number of elderly people in the world.Due to the lower elastin content of the posterior longitudinal ligament of the elderly,the lowering of the muscle strength of the trunk and lower back muscles,the osteoporosis of the elderly is reduced,the microstructure of the bone tissue is degenerated,and the incidence of lumbar degenerative diseases in the elderly is also increasing.The older the age,the more severe the osteoporosis and the higher the incidence of degenerative diseases of the spine.The development of surgical techniques presents a general trend of minimally invasive.The popularity and application of various spinal minimally invasive techniques in the clinic has also greatly accelerated the development of spinal surgery.Among them,the minimally invasive transforaminal lumbar interbody fusion technique is a channel system that directly exposes the facet joints and transverse processes through the multi-fissure muscle and the longest muscle gap for effective decompression and fusion.Compared with the traditional TLIF,it reduces the damage of muscle tissue,reduces the symptoms of back pain caused by postoperative scar healing and denervation of muscle tissue,and contributes to early functional recovery.OBJECTIVE: To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disorders with osteoporosis.To provide a theoretical basis for minimally invasive transforaminal lumbar interbody fusion for the treatment of elderly degenerative lumbar disease with osteoporosis.In order to improve the minimally invasive transforaminal lumbar interbody fusion with bone cement screw,it has been widely used in the clinical treatment of degenerative lumbar disease with fracture and loosening.Method:From August 2016 to August 2018,the lumbar intervertebral fusion was performed in our hospital for lumbar intervertebral degeneration.The age was greater than 65 years old.The main diagnosis was lumbar spinal stenosis,lumbar disc herniation and lumbar vertebrae within 2 degrees.Spondylolisthesis;all with primary osteoporosis and measured bone density T value of 1-5 segments of lumbar spine ?-2.5,but did not reach severe osteoporosis;clinical symptoms were consistent with lumbar CT and MRI,determined as a single section segment disc degeneration in patients with severe,a total of 40 patients have interbody fusion surgical indications.A randomized group was used for comparative analysis,including 20 males and 20 females,including 10 cases of lumbar disc herniation,17 cases of lumbar spinal stenosis,and 13 cases of lumbar spondylolisthesis within 2 degrees.Combined with clinical symptoms,physical examination and lumbar vertebrae Radiographic examination of the position,lumbar spine hyperextension and flexion X-ray,lumbar CT and lumbar MRI,and bone mineral density examination,20 patients underwent TLIF surgery(open group),and 20 patients underwent MIS-TILF surgery(minimally invasive group).,comparing the age,duration of disease,operation time,intraoperative blood loss,postoperative drainage,preoperative and postoperative visual analogue pain scores VAS and Oswestry dysfunction index,postoperative complications,postoperative bed rest and length of hospital stay.To analyze the clinical efficacy of the two procedures for the elderly with lumbar degenerative diseases and osteoporosis.Result: The operation was successfully completed in both groups.The minimally invasive group was lower than the open group(P<0.05)in terms of operation time,intraoperative blood loss and postoperative drainage.There were no significant differences in preoperative VAS and ODI scores between the two groups(P>0.05),which were comparable.At 7 days after operation and 1 month after operation,the VAS scores of low back pain were lower than those before operation(P<0.05).At the same time,the VAS scores of low back pain were lower than those of open group(P<0.05).There was no significant difference in postoperative ODI score between the two groups(P>0.05).The bed rest time and hospital stay in the minimally invasive group were shorter than those in the open group(P<0.05).No complications occurred in the minimally invasive group,and one patient developed complications in the open group.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion: Minimally invasive transforaminal lumbar vertebral fusion with bone cement fixation in elderly patients with degenerative lumbar disease and osteoporosis can not onlyshorten the operation time,reduce intraoperative blood loss and postoperative drainage,but also It can improve the patient's pain level,improve dysfunction,and also shorten bed time and hospital stay,so it has high clinical application value and is worth promoting.