| Objective:To study the effect of expandable interbody Cage surgery(uposterior unilateral discectomy,expandable interbody cage bone graft fusion)on spinal balance in the treatment of lumbar disc herniation.To further explore the clinical application value of expandable interbody Cage surgery in the treatment of lumbar disc herniation.Method:64 patients who meeting the inclusion criteria,underwent single-segment and unilateral lumbar disc herniation surgery in the spinal surgery ward of the Affiliated Sports Hospital of Chengdu Sport University from May 2019 to May 2020 were use number table randomly divided into expandable interbody Cage group(posterior unilateral discectomy,expandable interbody cage bone graft fusion)in 32 cases and Mis-TLIF group(Posterior unilateral spinal canal decompression,discectomy,intervertebral bone grafting and fusion bilateral screw rod system fixation)in 32 cases.Collect the patient's Sagittal Vertical Axis(SVA),Lumbar Lordosis(LL),Segmental Lordosis(SL),Sacral Slope(SS),Pelvic Til(PT),Coronal Balance Distance(CBD),Coronal Pelvic Tilt Angle(C-PT),Coronal Cobb Angle,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)at different time points before surgery,after surgery,1 month,3 months,and half a year after surgery and operation related informations for prospective study.The operations of the two groups were performed by two chief surgeons,the data collection was done by the author alone,and all the statistical was analysis by the SPSS23.0 software.Result:Finally,there were 60 cases be followed up for 6 months.They were20-73 years old with an average of(44.83±12.12)years old,with 27 females and 33 males.The are 30 cases in expandable interbody Cage group,age from 20 to 73 years old with an average of(44.70±12.79)years old,13 females and 17 males,with diseased segment:16 cases of L5-S1,11 cases of L4-L5,2 cases of L3-L4,1 case of L2-L3;The are 30 cases in Mis-TLIF group,age from 22 to 67 years old with an average of(44.97 ± 11.64)years old,14 females and 16 males,with diseased segment:18 cases of L5-S1,11 cases of L4-L5,0 cases of L3-L4,1 case of L2-L3.There is no statistically significant difference between the two groups of patients in age,gender,and diseased segment(P>0.05),indicating that the two groups are comparable.As for surgery-related conditions:The average operation time of the expandable interbody Cage group and Mis-TLIF group are respective(84.87±19.28)minutes and(167.90 ± 21.07)minutes,the average incision length are respective(5.88±0.93)cm and(2.53±0.13)cm,the average intraoperative blood loss are respective(124.00±30.69)ml and(396.63±24.12)ml,the average operation expenses are respective(4.52±0.13)thousand yuan and(5.26±0.15)thousand yuan,and the average number of hospital days are respective(14.6±3.31)days and(12.73±2.35)days.The expandable interbody Cage group is less than the Mis-TLIF group about operation time,intraoperative blood loss and operation expenses with the statistically significant(P<0.05).As for imaging parameters:Half a year after the operation,the SVA,CBD,and coromal Cobb angle of the two groups are both significantly smaller than those before the operation,and the LL is significantly larger than those before the operation and the difference is statistically significant(P<0.05),SL is larger than that before operation,the difference is in no statistically significant(P>0.05);SS is larger,PT is smaller than that before operation,the difference is statistically significant in the expandable interbody Cage group(P<0.05),and no no statistically significant in the Mis-TLIF group(P> 0.05),the C-PT of the expandable interbody Cage group is smaller than that before operation,and with no statistically significant of the difference(P>0.05),and the C-PT of the Mis-TLIF group is smaller than that before operation,and the difference is in statistically significant(P<0.05).Furthermore,the reduction of SVA in the Mis-TLIF group is better than that in the expandable interbody Cage group at the three time points after surgery,3 months after surgery,half a year after surgery and the difference is in statistically significant(P<0.05),the LL of the Mis-TLIF group is larger than the expandable interbody Cage group,otherwise the PT is smaller than the expandable interbody Cage group after operation with the difference in statistically significant(P<0.05).However,There are no significant difference in the changes of SL and SS at each time point between the two groups(P>0.05).At six months after operation,the decrease of CBD in the Mis-TLIF group is better than that in the expandable Cage group,and the difference is statistically significant.(P<0.05).The preoperative coronal Cobb angle between the two groups is compared in P>0.05,so the changes in the coronal Cobb angle at each time point between two groups are not comparable.There is no significant difference in the changes of C-PT at each time point between two groups(P>0.05).As for the curative effect:Half of a year after operation,both ODI index and VAS score of the two groups significantly are significantly decreased(P<0.05).The ODI index of the expandable interbody Cage group and the Mis-TLIF group are respective decreased from(32.27±7.72)points and(35.47±6.24)points before surgery to(2.57±1.19)points and(2.23±0.86)points for half a year after operation.There is no statistically significant difference between the two groups(P>0.05).The VAS score decreased from(7.47±0.68)points and(7.83±0.87)points before operation to(0.60±0.62)points and(0.30±0.47)points for the half a year after operation.There is no statistically significant difference between the two groups after operation and 1 month after operation(P>0.05).The Mis-TLIF group is lower than the expandable interbody Cage group at 3 months and half a year after operation,and the difference between them is statistically significant(P<0.05).Conclusion:1.The expandable interbody cage intervertebral fusion surgery is effective in treating single-segment lumbar disc herniation.The operation can improve and maintain the balance of sagittal plane and coronal plane by reducing SVA,CBD,coronal Cobb angle and increasing LL,SS and PT,which has high clinical application value.2.There is no significant difference in the curative effect and postoperative spinal balance between the expandable interbody cage intervertebral fusion surgery and Mis-TLIF surgery in the treatment of single-segment lumbar disc herniation,but the operation time,intraoperative blood loss and operation cost of the expandable interbody cage surgery are lower,so it's clinical comprehensive benefit is higher. |
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