Clinical Study Of Microscopic Assisted MIS-TLIF In The Treatment Of Lumbar Degenerative Diseases

Background: Lumbar degenerative diseases are the most common diseases in spinal surgery.Among a variety of approaches,transforaminal lumbar interbody fusion(TLIF)is one of the treatments of choice for a variety of Lumbar degenerative diseases.TLIF achieves good fusion rates,maintains the intervertebral space and foraminal dimension,and restores vertebral alignment.However,this technique requires an extensive amount of soft tissues to be dissected for facet complex resection and pedicle screw insertion.The significant damage this causes to muscles and soft tissues often results in severe postoperative low back pain,a long recovery time,and low spinal function.On this basis,the improved minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)can achieve the same clinical effect,and with mini-open incision,less muscle and nerve trauma,less blood loss,and faster recovery.It becomes an alternative to TLIF gradually by these advantages.However,MIS-TLIF requires the tubular retractor system,which causes the limited visibility and restricted working space.The complete exposure is the key to surgical operation.This study will compare the microscope with traditional cold light source to assist MIS-TLIF in the treatment of lumbar degenerative diseases.The safety and effectiveness provide a reference for clinically rational selection of surgical methods.Objective: To observe and compare the clinical effects and safety of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of Lumbar degenerative diseases between the assistant of microscope and cold light source.Methods: 106 patients with single-segment Lumbar degenerative diseases from the Department of Orthopaedics,Tangdu Hospital,Air Force Military Medical University from January 2014 to June 2017,treated with MIS-TLIF assisted by microscope or the cold light illumination,including 63 cases of microscope group and 43 cases of the cold light source group.In this retrospective study,surgical information,such as operative time,intraoperative radiation exposure,intraoperative hemorrhage,postoperative drainage,postoperative bedridden time,postoperative hospitalization days and complications.In addition,pre-op and post-op after3 months,6 months,and 12 months VAS score,ODI index,JOA score,and JOA improvement rates and fusion rates collected and compared between patients who received the two different treatments were compared.Results: Compared with between the microscope group and the cold light source group,there was no significant difference in the operation time and intraoperative radiation exposure(P>0.05).The intraoperative blood loss and postoperative drainage volume of the microscope group were less than those of the cold light source group,and the postoperative bedridden time and the postoperative hospitalization days was shorter(P<0.05).However,the complication rates and fusion rates were no statistical difference between the two groups(P>0.05).The VAS score,ODI index and JOA score in post-op 3 months,6 months,and 12 months were significantly improved compared(P<0.05);the microscope group was better than the cold light source group at the same postoperative time,and there were statistical differences(P<0.05).The difference of VAS score,ODI index,JOA score and JOA improvement rates between the preoperative and last follow-up of the microscope group were better than those of the cold light source group,and there was statistical difference(P< 0.05).Conclusion: Microscopy and cold light source assisted MIS-TLIF in the treatment of lumbar degenerative diseases were safe technique and effective.Relatively cold light source assisted MIS-TLIF,microscopy assisted MIS-TLIF with lessin intraoperative blood lossand postoperative drainage volume,shorter in the postoperative bedridden time and the postoperative hospitalization days,and better in clinical efficacy.