40 Cases Of Lumbar Degenerative Disease Treated By Minimally Invasive Intervertebral Fusion Via Intervertebral Aperture Approach Under Microscopic Eyepiece Auxiliary Channel

Objective Lumbar interbody fusion(LIF)has become a classic surgery for degenerative diseases of lumbar spine with definite curative effect.Transforaminal interbody fusion(TLIF)has also been fully recognized.With the continuous development of fusion methods,minimally invasive lumbar fusion technology has gradually been widely accepted with its unique advantages.In this study,microscopic eyepiece assisted minimally invasive transforaminal interbody fusion(MIS-TLIF)under Quadrant channel and traditional open TLIF are used to treat lumbar degenerative diseases.The clinical effects of the two surgical methods in patients with lumbar degenerative diseases are compared,and the advantages and disadvantages of the two methods are further analyzed,which provides a more reasonable and powerful basis for the selection of surgical methods for lumbar degenerative diseases and benefits the patients.Method From January 2015 to December 2017,87 patients with lumbar degenerative diseases admitted to our hospital were selected for retrospective analysis,including 48 cases of lumbar degenerative spondylolisthesis complicated with spinal stenosis,27 cases of lumbar disc herniation complicated with lumbar instability,10 cases of severe lumbar spinal stenosis,1 case of restenosis after decompression of lumbar spinal stenosis,1 case of relapse after laminectomy of lumbar disc herniation,which were divided into MIS-TLIF group(40 cases)and TLIF group(47 cases)according to different surgical methods.The MIS-TLIF group used Quadrant expandable channel combined with direct vision under eyepiece to perform lumbar interbody fusion viaintervertebral foramen approach,while the TLIF group used traditional lumbar interbody fusion via intervertebral foramen approach with a follow-up time of more than 1 year.Visual Analogue Scale(VAS)and Oswestry disability index(ODI)were used to evaluate the low back pain and lower limb pain of the two groups.Dynamic X-ray imaging(Simmons method)was used to evaluate intervertebral fusion.Two groups of patients were compared:(1)Perioperative data: intraoperative blood loss,intraoperative fluoroscopy times,operation time,postoperative drainage volume,postoperative field time and hospitalization time;(2)Complications: presence or absence of spinal cord reactive edema,cerebrospinal fluid leakage,surgical incision infection,urinary retention,nerve root injury,intervertebral fusion cage displacement,internal fixation loosening and fracture,etc.,to evaluate surgical safety;(3)Intervertebral fusion: X-ray films more than 6 months after the operation indicate that there is no deviation of the intervertebral fusion device and no clear area around it,and fusion is performed when the angle change of fusion segment of dynamic X-ray films is not more than 5 degrees;(2)Clinical efficacy: The pain visual analog score(VAS)and Oswestry dysfunction index score(ODI)were compared between groups and within groups.Result All 87 patients successfully completed the operation.There was no significant difference in age,sex,BMI index and other general data between the two groups,which was comparable.1.perioperative data: the average operation time(97.33±5.413min)in MIS-TLIF group is longer than that in TLIF group(81.36±5.054min),and the number of intraoperative fluoroscopy(6.15 0.86)is higher than that in TLIF group(4.26 0.71),with statistically significant difference(t=14.211,11.257,p < 0.001);The intraoperative blood loss and postoperative drainage volume(113.13±7.31 ml,64.90±6.40ml)in MIS-TLIF group were less than those in TLIF group(175.74±8.14 ml,90.21±7.39ml),and thepostoperative time and hospitalization time(3.68 0.69 d,8.35 1.25 d)were less than those in TLIF group(6.15 0.72 d),10.34 0.98 d),the difference was statistically significant(t =-37.458,-16.923,-16.220,-8.299,all p < 0.001).2.interbody fusion rate: the interbody fusion rate in MIS-TLIF group was 97.5%,and that in TLIF group was 100%,with no significant difference(p > 0.05).the average time of bone graft fusion was 6 months.3.Complications: Both groups of patients successfully completed the operation without dural rupture,cerebrospinal fluid leakage,nerve root injury,nail breakage,rod breakage,internal fixation loosening and fusion device displacement.One patient in TLIF group developed wound infection and healed after dressing change.4.clinical efficacy: the VAS score and ODI score of postoperative lumbago and lower limb pain in the two groups were significantly lower than those before operation,with statistically significant difference(all p < 0.01);The relief of lumbago in MIS-TLIF group was significantly better than that in TLIF group([VAS(1.80±0.61)vs(3.01 0.68))3 days after operation,the difference was statistically significant(P < 0.001).There was no significant difference in VAS scores of lower limb pain,lumbago and lower limb pain between the two groups 3 days after operation(all P > 0.05).There was no significant difference in ODI scores 1 month and 1 year after operation(all P > 0.05),and there was no significant difference in ODI scores 1 month after operation(P=0.064).Conclusion Quadrant expandable channel combined with direct vision under eyepiece for lumbar interbody fusion via intervertebral foramen approach has definite curative effect in treating degenerative diseases of lumbar spine.It can achieve clinical effect similar to TLIF operation,with less intraoperative trauma,shorter bed rest and discharge time,more significant relief of postoperative lumbago,favorable for patient recovery and early functional exercise,more in line with the concept of enhancedrecovery after surgery(ERAS),and worthy of promotion.However,the disadvantages of long operation time,large radiation dose during operation and steep learning curve require clinicians to strictly grasp the operation indications and formulate more reasonable and effective treatment plans for patients.