Clinical Comparison Of MIS-TLIF And TLIF For Lumbar Spondylolisthesis Associated With Lumbar Spinal Stenosis

Objective: To analyze the difference in clinical outcomes between TLIF and MISTLIF for patients with lumbar spondylolisthesis complicated by lumbar stenosis.Methods: The data of patients with lumbar spinal stenosis complicated with lumbar spondylolisthesis hospitalized in The Affiliated Hospital of Yan ’an University from September 2018 to March 2021 were collected and analyzed.Forty-eight patients(23males and 25 females,aged 56-68 years)eligible for inclusion and exclusion of standard vertebra were selected.Among them,25 patients received TLIF surgery,which was in the TLIF group,with an average age of 62.68±2.56 years and an average course of disease of23.12±7.07 months.Lumbar spondylolisthesis: degree ⅰ in 9 cases,degree ⅱ in 16 cases;There were 14 cases of L4 spondylolisthesis and 11 cases of L5 spondylolisthesis.Twentythree patients were mis-TLIF group,with an average age of 63.70±2.42 years and an average course of disease of 22.09±7.01 months.There were 8 cases of lumbar spondylolisthesis with grade ⅰ and 15 cases with grade ⅱ.Lumbar spondylolisthesis: 13 cases of L4 spondylolisthesis,10 cases of L5 spondylolisthesis.The length of surgical incision,duration of surgery,intraoperative blood loss,intraoperative fluoroscopy times,postoperative drainage,postoperative ground time and average length of hospital stay were compared between the two groups.Low back pain,lower limb pain VAS score,ODI dysfunction index score and M-JOA score were performed for each patient before and after operation.Postoperative interbody fusion was evaluated by SUK standard.The above data were analyzed statistically.Results: All 48 patients successfully completed the procedure.In the TLIF group,the mean incision length(5.35 ± 0.36 cm),intraoperative blood loss(224.80 ± 29.31 ml),postoperative drainage volume(184.40 ± 31.63 ml),postoperative landing time(3.32 ±0.47 d),mean hospital stay(14.52 ± 4.04 d),operative time(3.02 ± 0.31 h),and number of intraoperative fluoroscopies(4.64 ± 0.57 times)were recorded.The average incision length(3.43 ± 0.25 cm),intraoperative blood loss(111.35 ± 28.33 ml),postoperative drain volume(85.22 ± 9.94 ml),postoperative landing time(2.04 ± 0.56 d),average hospital stay(10.13 ± 2.11 d),and postoperative blood loss(111.35 ± 28.33 ml)in the MIS TLIF group.The operative time was(3.77 ± 0.64 h),and the number of intraoperative fluoroscopy sessions was(7.26 ± 0.68 times),with a statistically significant difference between the two groups(P < 0.05).In the same treatment group,preoperative low back pain VAS scores were compared,and both groups improved postoperatively;A comparison between the two groups showed that the difference between the two groups at 14 days and 1 month after surgery was statistically significant(P < 0.05).The VAS scores of leg pain were compared preoperatively in the same treatment group,and both groups improved postoperatively,with no statistical significance between the two groups(P > 0.05).Within the same treatment group,preoperative ODI and m-joa scores decreased postoperatively in both patients.The difference between the two groups at 14 days and 1 month after surgery was statistically significant(P < 0.05).The rates of interbody fusion were similar in the two groups(P > 0.05).The difference was not statistically significant.Conclusion1.The TLIF procedure has good clinical outcomes compared with MIS-TLIF procedure in patients with lumbar spondylolisthesis complicated by lumbar stenosis.2.MIS-TLIF has many advantages,such as less intraoperative blood loss and postoperative drainage volume,less surgical trauma,shorter hospital stay,and faster recovery of postoperative patients,which should be widely used in the clinic.