| Background:With the development of society,more and more people have lumbar degenerative diseases caused by degeneration of vertebral body,intervertebral disc,facet joint and soft tissue.Lumbar degenerative diseases mainly include lumbar spinal stenosis,lumbar disc herniation,degenerative lumbar spondylolisthesis,degenerative lumbar kyphosis and degenerative facet joint diseases.Lumbar degenerative diseases often cause irreversible damage to nerves and seriously affect the quality of life of patients.For patients with severe symptoms and a long history,surgical treatment is the preferred clinical option.Transforaminal lumbar interbody fusion(TLIF)is widely used in the treatment of lumbar spine diseases.Full decompression and interbody fusion through unilateral transforaminal approach can effectively reduce nerve root traction and dural sac injury,and reduce the incidence of neurogenic complications.Since the TLIF operation was carried out,the traditional operation has been the "golden standard" for spinal surgeons to treat lumbar spine diseases.Although the traditional TLIF operation can effectively improve the symptoms of patients and achieve good clinical efficacy,it requires a lot of anatomy and traction of soft tissue,especially for the paravertebral muscles.The biomechanical function of paravertebral muscles is severely impaired,which affects the stability of lumbar spine.It is easy to cause complications such as sagittal imbalance and adjacent segment disorder(ASD)after operation,thus affecting the long-term clinical outcomes.In order to reduce the complications after operation,some scholars proposed minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).Under the premise of ensuring the effects of nerve decompression and interbody fusion,this surgical method can reduce the injury of paravertebral muscles as much as possible by separating muscular space suddenly,and preserve the biomechanical function of paravertebral muscles more completely,so as to reduce the occurrence of corresponding complications and improve the clinical outcomes.Objective:To compare the clinical outcomes,the improvement of sagittal imbalance and the occurrence of ASDeg of MIS-TLIF and traditional TLIF in the treatment of single-level lumbar spine diseases.Method:The imaging and clinical data of 121 patients with more than five-year follow-up who underwent L4/5 single-segment TLIF from January 2009 to January 2015 were retrospectively analyzed.Among them,42 were males and 79 were females,aged 38-85 years,with an average of(56.8±9.5)years.Preoperative diagnosis was lumbar spinal stenosis,of which 52 cases were caused by lumbar degenerative spondylolisthesis.57 cases underwent MIS-TLIF operation and 64 cases underwent traditional TLIF operation.There were 22 males and 35 females in MIS-TLIF group,aged 38-85 years,with an average age of(57.7± 10.0)years.The course of disease was 6-360 months,with an average of(70.6± 85.6)months.The follow-up time was 60-73 months,with an average of(64.4±3.7)months.23 of 57 patients were caused by degenerative spondylolisthesis.In the traditional group,there were 20 males and 44 females,aged 38-77 years,with an average age of(56.0 ± 9.1)years,with a course of 6-360 months(80.8±83.2)months,and a follow-up period of 60-80 months(64.0± 3.7)months.Of the 64 patients,29 were caused by lumbar degenerative spondylolisthesis.Imaging evaluation indicators included sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence angle(PI),sacral slope(SS),pelvic tilt angle(pelvic tilt angle).PT,L4/5 fusion segment angle(FSA),disc height(DH)and range of motion(ROM).SVA(>40 mm)was defined as sagittal imbalance,and facet joint violation(FJV)was evaluated by Babu scoring system after operation.The clinical efficacy was evaluated by visual analogue score(VAS),Japanese Orthopaedic Association score(JOA)and Oswestry disability index(ODI).Results:All patients were followed up for more than 5 years.The follow-up period ranged from 60 to 80 months,with an average of(64.1 ± 3.7)months.The mean operative time of MIS-TLIF group was(201.6± 50.7)min,and that of TLIF group was(178.8 33.3)min.The difference was statistically significant(t=2.957,P<0.01).The mean intraoperative bleeding volume of MIS-TLIF group was(134.6±96.9)ml,and that of TLIF group was(258.4± 101.8)ml,with statistical significance(t=-6.836,P<0.01).The incidence of FJV in L4 superior articular process was 36.8%in MIS-TLIF group,including 24 cases of grade 1,14 cases of grade 2 and 4 cases of grade 3.The incidence of FJV in L4 superior articular process was 38.3%in traditional TLIF group,including 33 cases of grade 1,12 cases of grade 2 and 4 cases of grade 3.There was no significant difference in the incidence of FJV between the two groups(?2==1.093,p=0.779).There was no significant difference in preoperative SVA,TK,LL,PI,SS,PT and FSA between the two groups.After 5 years follow-up,SVA and PT decreased,LL,TK,SS and FSA increased in both groups.There was no significant difference in SVA,TK,LL,PI,SS,PT and FSA between the two groups.The incidence of preoperative sagittal imbalance was 38.6%in MIS-TLIF group and 32.8%in traditional TLIF group.There was no significant difference between the two groups(?2=0.440,P=0.507).After 5 years follow-up,15 cases(68.2%)in MIS-TLIF group recovered sagittal balance,while 13 cases(61.9%)in traditional TLIF group recovered sagittal balance.There was no significant difference between the two groups(?2=0.186,P=0.666).There was no significant difference in preoperative L3/4,L4/5 and L5/S1DH between the two groups.After 5 years follow-up,L3/4DH decreased in both groups.MIS-TLIF group decreased by 5.7%±6.1%,and traditional TLIF group decreased by 9.3%± 7.4%.The difference was statistically significant(t=-2.921,p<0.01).The L4/5DH increased in both groups.MIS-TLIF group increased by 20.7%±30.0%,and traditional TLIF group increased by 23.2%± 28.2%.There was no significant difference between the two groups(t=-0.459,p=0.647).L5/S1DH decreased in both groups.MIS-TLIF group decreased by 5.2%±8.5%,and traditional TLIF group decreased by 11.4%±12.4%.The difference was statistically significant(t=-3.167,p<0.01).There was no significant difference in L3/4,L4/5 and L5/S1DH between the two groups after operation.There was no significant difference in preoperative L3/4,L4/5 and L5/S1ROM between the two groups.After five years follow-up,L3/4ROM increased in both groups.MIS-TLIF group increased by 1.3°± 1.9°,and traditional TLIF group increased by 2.5°± 2.5°.The difference was statistically significant(t=-2.841,p<0.01).L4/5ROM decreased in both groups.MIS-TLIF group decreased by 1.8°± 2.8°,and traditional TLIF group decreased by 1.9°± 2.9°,with no significant difference(t--0.062,p=0.951).L5/S1ROM increased in both groups.MIS-TLIF group increased by 1.1°± 1.7°,and traditional TLIF group increased by 1.9°± 1.9°.The difference was statistically significant(t=-2.419,p<0.05).The average L3/4ROM of MIS-TLIF group after operation was 6.0°± 2.7°,while that of traditional TLIF group was 7.8°±3.0°.The difference was statistically significant(t=-3.519,p<0.01).The average L4/5ROM of MIS-TLIF group after operation was 3.6°± 2.7°,and that of traditional TLIF group was 3.6°± 2.3°.There was no significant difference(t=0.004,p=0.997).The average L5/ROM of MIS-TLIF group after operation was 6.6° ± 2.8°,and the traditional TLIF group was 8.0° ± 2.0°.The difference was statistically significant(t=-2.978,p<0.01).After 5 years follow-up,19 cases of ASDeg occurred in MIS-TLIF group,and the incidence of which was 33.3%.Among them,12 cases only occurred in the upper segment,6 cases only occurred in the lower segment,and 1 case simultaneously occurred in the upper and lower segments.38 cases of ASDeg occurred in the traditional TLIF group,and the incidence was 59.4%.Among them,20 cases only occurred in the upper segment,12 cases only occurred in the lower segment,and 6 case simultaneously occurred in the upper and lower segments.The incidence of ASDeg was significantly different between the two groups(?2=8.206,P<0.01).There was no significant difference in preoperative VAS,JOA and ODI scores between the two groups.After 5 years of follow-up,the VAS and ODI scores in both groups decreased,and JOA scores increased.There was no significant difference in postoperative VAS,JOA and ODI scores between the two groups.Conclusion:Both MIS-TLIF and traditional TLIF can achieve good clinical results in the treatment of single-segment LSS,and can effectively improve the sagittal imbalance.There is no significant difference in the incidence of FJV,while the incidence of ASDeg after MIS-TLIF is lower than that of traditional TLIF. |
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