A Comparative Study On Evaluation Index System During Perioperative Period Of MED-MISTLIF And PLIF In The Treatment Of Lumbar Degenerative Diseases

Objective To compare the perioperative indexes of traditional open PLIF(posterior lumbar interbody fusion,后路腰椎椎体间融合术)with MED-MISTLIF(microendoscopic disectomy minimally invasive transforaminal lumbar interbody fusion,微创椎间盘镜辅助下经椎间孔入路腰椎椎体间融合术)assisted by discoscopy.To establish the evaluation index system of MED-MISTLIF in perioperative period,to establish the standard operation method and procedure of MED-MISTLIF,and to explore the safety and effectiveness of MED-MISTLIF in treating lumbar degenerative instability and spinal stenosis secondary to spondylolisthesis.Methods Patients with lumbar degenerative diseases treated by single-segment fusion from June 2019 to June 2020 in our hospital were selected and operated with traditional open PLIF technique and MED-MISTLIF technique.The incision length,operation time,intraoperative bleeding volume,postoperative drainage volume,postoperative descending time,preoperative and postoperative VAS(Visual analogue scale,视觉模拟评分法)and the JOA(Japanese orthopaedic association scores,日本骨科协会评估治疗分数)assess treatment scores for pain and function assessment and analysis of the efficacy of the treatment;document surgical complications and infections to analyze the safety of the procedure.Results Among 142 eligible patients,64 patients were treated with traditional open PLIF technology and 78 patients were treated with MED-MISTLIF technology.All patients successfully completed the operation.There were no postoperative complications such as iatrogenic spinal cord nerve root injury and no postoperative infection.(1)Operation status:distribution of fused segments:PLIF group:lumbar5-sacral 120 Cases,lumbar 4-544 Cases;MED-MISTLIF group: lumbar 5-sacral123 Cases,lumbar 4-555 Cases.The normal test revealed a non-normal distribution of data,expressed as a median(interquartile range).Incision length(cm): PLIF :8.0(7.0,9.5),MED-MISTLIF:2.0(2.0,2.0)(decompression fusion approach incision);operation time(min): PLIF : 120.0(108.0,143.8),MED-MISTLIF :140.0(120.0,155.0);intraoperative bleeding volume(ml):PLIF:300.0(200.0,400.0),MED-MISTLIF : 75.0(65.0,85.0);Postoperative drainage(ml): PLIF :500.0(290.0,600.0),MED-MISTLIF : 35.0(25.0,55.0);Postoperative time(d):PLIF : 7.0(7.0,8.0),MED-MISTLIF : 6.0(6.0,6.0).(2)Efficacy evaluation :Non-parametric test was used to analyze the difference.The VAS and JOA scores of low back pain,leg pain and leg pain of the patients treated by two methods before and7 days after the operation were P <0.001,which had statistical significance.It showed that the symptoms of the patients in both groups after the operation were significantly less than those of the patients before the operation,and the function of the lower back leg was well recovered.By comparing the data of the two groups,we found that the difference between the JOA score improvement index and the VAS score of preoperative and postoperative low back pain was statistically significant(P<0.01).The average rank of MED-MISTLIF group was higher than that of PLIF group,indicating that the relief of low back pain after operation was more obvious and the overall improvement was good in MED-MISTLIF group.The difference between the VAS score of leg pain was P >0.05,and there was no significant statistical difference between the two groups.The improvement rate after treatment in the two groups was tested and conformed to normal distribution(P<0.001),which was statistically significant.The improvement rate after treatment in PLIF group was 39%±11%.The improvement rate of post-treatment score in MED-MISTLIF group was 45%±10%,indicating that both groups were effective after operation.The improvement rate of post-treatment score in MED-MISTLIF group was higher than that in PLIF group.Conclusions(1)By comparing two kinds of lumbar fusion methods in our hospital,this experiment defined the operation and evaluation indexes of MED-MISTLIF technique during the perioperative period,which provided a reference for the selection of operation methods for clinical treatment of lumbar degenerative diseases;(2)established the standard MED-MISTLIF operation methods and procedures;(3)compared with PLIF,MED-MISTLIF technique for treatment of lumbar instability and secondary spondylolisthesis stenosis achieved the purpose of small operation incision,small operation bleeding and early descending time,and achieved satisfactory curative effect,which was safe and effective.