Comparison Of Minimally Invasive And Open Transforaminal Lumbar Interbody Fusion Through Wiltse Approach And Conventional Approach In The Treatment Of Degenerative Lumbar Disease And Clinical Study

Part 1:Objectives:To measure the distances between the midline and the intermuscular planes formed by the multifidus and longissimus muscles at each lumbar level(L1-S1)and discuss the distance distribution in Chinese.Methods:One hundred patients(48 males and 52 females)suffering from low back pain and with lumbar MRI records were selected randomly in our hospital from January 2013 to February 2013.The distance from the convexest point outside the multifidus muscles to the midline at each level between L1 and S1 was measured in MRI scans.The distance distribution at each level was determined by using the statistical methods.The correlation between sex and the measured outcomes was identified.Results:There was no significant difference between men and women in the same segment(P>0.05);there was significant difference between different segments of the same sex(P<0.05),and the average distance increased gradually from L1/2 to L5/S1.The distance between horizontal polyfidus muscle and longissimus muscle space to spinous process bisector of each lumbar intervertebral disc was significantly different,and the distance decreased gradually with the increase of lumbar intervertebral segment(P<0.05).Conclusions:The distances between the lumbar intermuscular planes and midline in Chinese gradually decrease from L5/S1 to Ll/2.No significant correlations exist between males and females.Preoperative measurements in MRI scans provide valuable reference to determine the precise incision in Wiltse’s paraspinal surgical approach.Part 2:Objective:To investigate the feasibility and early curative effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of low lumbar degenerative disease.Methods:A total of 30 patients underwent MIS-TLIF for low lumbar degenerative disease.They contained 12 cases of Ⅰ～Ⅱ degree spondylolisthesis,8 cases of degenerative lumbar spinal stenosis with segmental instability and 10 cases of protrusion of lumbar intervertebral disc.All the patients underwent one-level fusion by the same surgeon.Results:The surgical time,intraoperative blood loss volume,X-ray exposed time and the first leaving bed time after surgery were 127～209(168±41)min,23～361(192 ± 169)ml,72～136(104±32)s,1.4～3.8(2.6±1.2)d.VAS of the preoperative and the last follow-up were(7.20 ± 1.02)points and(1,71 ± 0.66)points,the difference had statistical significance(P<0.01).The rates of fusion and complication incidence were 100%and 0%at the last follow-up.The X-ray film showed that the cage in intervertebral space was in good position and pedicle screws had not any displacement or snap.Conclusions:MIS-TLIF is appropriate for Ⅰ～Ⅱ degree spondylolisthesis,degenerative lumbar spinal stenosis and protrusion of lumbar intervertebral disc and has an advantage of less blood loss and trauma.But it takes more time to finish the operation and X-ray exposing time is more.Part 3:Objective:To compare clinical result of minimally invasive transforaminal lumbar interbody fusion(TLIF)and open TLIF through Wiltse approach and conventional approach in treatment of degenerative lumbar disease.Methods:Thirty-six and 46 patients of Wuxi People’s Hospital who underwent minimally invasive TLIF(MIS-TLIF)through Wiltse approach and TLIF through conventional approach separately were selected.The operating time,blood loss,creatine kinase,the leaving bed time,postoperative complications,and intervertebral fusion rate were recorded.The function of lumbar and legs was evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI).The operating time,blood loss,creatine kinase,the leaving bed time,postoperative complications,intervertebral fusion rate were compared between MIS-TLIF group and TLIF group.VAS and ODI were compared between MIS-TLIF group and TLIF group pre-and post-operatively.Results:The operating time,blood loss,postoperative creatine kinase(3 days),the leaving bed time in the MIS-TLIF group were significantly less than those in the group of TLIF(all P values<0.01).The rate of complication and intervertebral fusion at 1 year between two groups wasn’t significantly different(all P values>0.05).VAS and ODI of 1 year were significantly lower than preoperative in both groups(all P values<0.01),however,there were no significant differences neither at preoperative or final follow-up between groups(all P values>0.05).Conclusions:MIS-TLIF is an effective way to treat degenerative lumbar disease.It can reduce the operation wound,hemorrhage during operation and promote early rehabilitation of patients.