Clinical Research Of MIS-TLIF Assisted By Quadrant System In The Treatment Of Lumbar Degenerative Disease

Objective:To explore the clinical effect of mini-invasive transforaminal lumbarinterbody Fusion (MIS-TLIF) assisted by Quadrant system for the treatment oflumbar degenerative disease,and compare with open transforminal lumbar interbodyfusion.Methods:From December2011to December2013, a whole of52patients whowere under lumbar degenerative diseases were divided randomly into two groupsand underwent different types of transforaminal lumbar interbody fusion surgery.22cases in MIS-TLIF group,10male and12female with ages from42to70(average53.8years), received MIS-TLIF assisted by Quadrant system. There were9caseswith lumbar disc herniation accompanying degenerative instability,6cases withlumbar spinal stenosis,4cases with spondylolisthesis,3cases with recurrent lumbardisc herniation.The rest30cases in open TLIF group,14male and16female withages from36to76(average53.2years), underwent traditional open TLIF surgery.There were13cases with lumbar disc herniation accompanying degenerativeinstability,7cases with lumbar spinal stenosis,6cases with spondylolisthesis,4caseswith recurrent lumbar disc hernation.All the patients were treated with percutaneouspedicle screw fixation(sextent system),lumbar canal decompression,interbody fusionwith autograft and cage under Quadrant system.Before surgery, there were no significant differences between the2groups in gender,age,situation,VAS(visualanalogue scale,ODI (Oswestry disability index).Operation time,blood loss,volume ofincision drainage,time of ambulation,hospital stay, analgesics use, and radiationexposure time were observed and compared between the two groups.VAS and ODIwere used to evaluate pain and function in perioperative and follow-up time.Aftersurgery, the radiography(X-ray) was carried out to demonstrate the fusion status.Results:All cases had been followed up among9-18months，average of10.5months.The group of MIS-TLIF was longer in operating time (P <0.05) and inradiation exposure time and dose than the group of open-TLIF(P<0.05).Significantdifferences were found in surgical blood loss,surgical draining loss after operationtime of ambulation,hospital stay,analgesics use between open TLIF group andMIS-TLIF group which were less in MIS-TLIF group.The scores of VAS and ODI inMIS-TLIf group were more significant less than those in Open TLIF group (P <0.05).According to Macnab criteria,In MIS-TLIF group, there was1case of leakageof cerebrospinal fluid and cured by expectant treatment,1case of limited necrosis ofincision margin and cured by chang dressings.In open TLIF,there were2cases ofdural tear and cured by expectant treatment,1case of Superficial wound infection andcured by chang dressings. None of nerve root injury was found in either MIS-TLIFor open TLIF group. Postoperative radiography showed no evidence of instrumentfailure and all cases got bone fusion in the2groups.Conclusions:MIS-invasive Transforaminal Lumbar Interbody Fusion Assistedby Quadrant System，which is less injury, less blood loss, less hospital stay, andsatisfied function recovery, is a safe and effective minimally invasive surgicalmethod for lumbar degenerative diseases.