| Background:Lumbar spondylolisthesis is a common spinal disease in orthopedics,this is a pathological process of lumbar vertebral body slipping forward to the adjacent vertebral body,which may caused by congenital dysplasia,trauma,strain and other reasons.Among them,degenerative spondylolisthesis is mainly caused by long-term instability of the lower lumbar spine and increased stress,which causes abrasion of the corresponding facet joints.Under the combined action of various factors such as intervertebral disc degeneration,intervertebral instability,and anterior ligament relaxation,the degenerated vertebral body gradually slips off.Serious degenerative spondylolisthesis may lead to different degrees of foraminal stenosis,which may appear repeatedly in the symptom such as back pain,leg pain and intermittent claudication,and the pain may radiate to the hip and the back of the thigh.Transforaminal lumbar intervertebral fusion(TLIF)was first proposed by Harms in 1982.TLIF can provide sufficient space for discectomy,spinal canal decompression,and intervertebral fusion via unilateral facet joint resection.It can effectively avoid iatrogenic nerve root traction and dural injury.Foley et al.were the first to report minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)by tubular channel technology.After that,more and more clinical studies have demonstrated that MIS-TLIF can effectively reduce intraoperative blood loss,postoperative pain and analgesic dosage.Patients after MIS-TLIF were able to walk early and spend less time in hospital.Nowadays,MIS-TLIF has become one of the main surgical method to treat degenerative spondylolisthesis.Clinically,most of the spondylolisthesis patients with bilateral foraminal stenosis mainly presented unilateral symptoms,some patients may accompany mild contralateral symptoms,and only a small number of patients have bilateral symptoms.For these patients with unilateral symptoms on one side and mild symptoms on contralateral side,the range of decompression is still controversial.Some scholars believe that we just need to perform decompression on the main symptom side,while other scholars believe that the contralateral side also need to be decompressed.Therefore,for those patients with major symptoms on one side and mild symptoms on the other side,the necessity of contralateral decompression in MIS-TLIF is still worth discussing.The purpose of this study was to investigate the clinical and radiographic data of single-segment lumbar degenerative spondylolisthesis with foraminal stenosis patients who underwent MIS-TLIF for unilateral decompression.These patients presented with major symptoms on one side and mild symptoms on contralateral side.We compared the patients’ relevant radiographic index of intervertebral foramen,intervertebral space and spinal canal on both sides,and assessed the postoperative clinical results.Finally,these follow-up measurements were used to investigate the necessity for routine performing contralateral foraminal decompression during MIS-TLIF,for those degenerative spondylolisthesis with bilateral foraminal stenosis patients with major symptoms on one side and mild symptoms on contralateral side.Objective:We aimed to investigate the clinical results and morphologic changes in the intervertebral foramen after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and analyze the necessity of routinely performing contralateral intervertebral foraminal decompression in lumbar degenerative spondylolisthesis with foraminal stenosis cases with bilateral symptoms when the symptoms were mild on one side.Methods:72 single-level degenerative lumbar degenerative spondylolisthesis with foraminal stenosis patients with bilateral symptoms(one side was mild)from December 2012 to December 2017 were included,all of whom underwent unilateral approach MIS-TLIF.There were 17 males and 55 females,with an average age of 52±11 years(23-80 years).49 and 23 cases associated with Meyerding grade Ⅰ and Ⅱ spondylolisthesis.2 cases of L3-4,51 cases of L4-5,19 cases of L5-S1.Preoperative and postoperative foraminal height(FH),superior foraminal width(SFW),middle foraminal width(MFW),inferior foraminal width(IFW),disc height(DH),distance from the existing nerve root to the upper edge of the lower pedicle(RTP),and contralateral side spinal canal area(CSCA)were measured at surgical and contralateral side by CT.Clinical outcomes were evaluated using the Visual Analogue Scale/Score(VAS),the Oswestry Disability Index(ODI)and Japanese Orthopaedic Association Scores(JOA).VAS score of 0～3 was defined as mild symptom.Results:All patients were followed up for 2 years or more,with an average of 30.5 months(24-36 months).The preoperative surgical and contralateral side values of FH,DH,SFW,MFW,IFW,RTP and CSCA were 13.03±2.66mm,12.97±2.88mm;6.14±1.50mm,6.51±1.37mm;8.42±2.23mm,8.11±2.15mm;10.56±2.30mm,10.43±2.12mm;4.87±1.16mm,5.04±1.38mm;5.97±2.04mm,6.7±2.05mm;164.36 ±37.13mm.At the last follow-up,the values of surgical and contralateral side were 16.23± 2.48mm,16.10±2.42mm;8.18±1.58mm,8.42±1.54mm;8.71±2.10mm,8.24 ±1.97;11.36±2.58mm,11.31±2.71mm;4.87±1.16,5.04±1.38;8.58±1.26mm,9.14± 1.77mm;211.59±48.12mm2.The postoperative surgical and contralateral side values of FH,MFW,DH,RTP all increased significantly(P<0.05),and there was no significant difference in the increase values of FH,MFW,DH,RTP between the both side(P>0.05).One patient(1%)had transient pain and numbness of contralateral lower limb immediately after operation,which was gradually relieved after conservative treatment.The preoperative average VAS scores of low back pain,VAS scores of leg pain,JOA scores and ODI scores were 6.11±1.67,5.97±1.84,9.81±2.81,22.01 ±5.77 respectively.At the last follow-up,the values were 2.15±1.62,1.72± 1.45,20.9± 3.96 and 10.51±6.57 respectively.The VAS,ODI and JOA scores all improved significantly at the last follow-up(P<0.05).Conclusion:MIS-TLIF with unilateral decompression can improve the FH,DH,IFW and RTP in both sides significantly.Therefore,for these lumbar degenerative spondylolisthesis patients with bilateral foraminal stenosis and bilateral symptoms when the symptoms were mild on one side,it is generally unnecessary to perform contralateral foraminal decompression. |
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