Treatment Of Lumbar Spinal Stenosis With Bilateral Radicular Symptoms Using A Combination Of Minimally Invasive Transforaminal Lumbar Interbody Fusion And Microendoscopic Discectomy

Objective: Minimally invasive transforaminal lumbar interbody fusion(MI-TLIF) is gradually popularized a new minimally invasive surgicaltechnology for the treatment of lumbar spinal stenosis(LSS) in recentyears. Although the minimally invasive advantages is obvious,itincreases the complexity and surgery time of operation for bilateraldecompression. This paper aimed to investigate the recent clinical effectsof the combined use of minimally invasive transforaminal lumbarinterbody fusion (MI-TLIF) and microendoscopic discectomy (MED) forthe treatment of lumbar spinal stenosis (LSS) with bilateral radicularsymptoms.Methods:A total of86cases of single level lumbar spinal stenosis withbilateral radicular symptoms patients treated in our hospital fromSeptember2011to February2013were retrospectively analyzed.Theminimally invasive surgeries were performed by paraspinal muscleapproach in44patients; one side underwent transforaminaldiscectomy,decompression and fusion surgery using a single cage andpedicle rod screw system via Quadrant system,while contralateral sideunderwent microendoscopic discectomy and decompression. There were24males and20females,33cases of L4/5level and11cases of L5/S1level; the age was from51to77years with an average of63.9years.Other42patients with the same disease underwent traditional posterior lumbar interbody fusion (PLIF) surgery during the same period. Therewere23males and19females,32cases of L4/5level and10cases ofL5/S1level; the age was from52to76years with an average of64.4years. Data concerning incision length, blood loss, surgery time, time ofbed rest,Visual Analogue Scale(VAS) and Oswestry Disability Index(ODI)score were analyzed statistically.Results:The combined use of MI-TLIF and MED (minimally invasivegroup)has many advantages compared to the traditional PLIF. Statisticalsignificance was reached in terms of incision length, blood loss and thetime of bed rest following surgery(P<0.05),but there was no significantdifference in the surgery time of the two groups. All patients werefollowed up for one year. VAS and ODI score showed significantly betterimprovement at5day,1month,3month,6month for minially invasivegroup versus traditional group patients,but were similar at1year aftersurgery.Conclusion:The combined use of MI-TLIF and MED for the treatment oflumbar spinal stenosis with bilateral radicular symptoms has theadvantages of shorter length of incision, reduced blood loss, shorter bedrest time, improved outcomes and shorter recovery times.It provides anew choice for the treatment of lumbar spinal stenosis with bilateralradicular symptoms.It avoids the complexity of the bilateral MI-TLIF,and reduces the surgical trauma. It’s a much more minimally invasive innovation resulting from the combination of two kinds of minimallyinvasive techniques.