The Clinical Effect Comparision Of Minimally Invasive Transforaminal Lumbar Interbody Fusion(MIS-TLIF) Assisted With Microscope And Traditional Open TLIF In Treatment Of Lumbar Spondylolisthesis

Objective To explore and compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) assisted with microscope and traditional open TLIF in treatment of lumbar spondylolisthesis.Methods Between January 2011 and June 2012,52 patients(MIS group) with lumbar spondylolisthesis underwent MI-TLIF assisted with microscope, there were 50 patients in open group underwent traditional open TLIF. The MIS group include 29 males and 23 females at the age of 32-67 years(average,46years). The median disease duration was 3.2 years(range, 3 months to 6 years). There were 38 cases of lumbar isthmic spondylolisthesis and 14 cases of degenerative spondylolisthesis; 12 cases had stenosis secondary to lumbar spondylolisthesis. The affected segments were L4, 5(29 cases) and L5, S1(23 cases). According to the Meyerding evaluating system, 24 cases were classified as degree I and 28 cases as degree II. The open group include 26 males and 24 females at the age of 34-66 years(average, 48 years). The median disease duration was 3.5 years(range, 4.5 months to 6 years). There were 37 cases of lumbar isthmic spondylolisthesis and 13 cases of degenerative spondylolisthesis. The affected segments were L4, 5(28 cases) and L5, S1(22 cases); 23 cases were classified as degree I and 27 cases as degree II. No significant difference were found in age, gender, disease duration time,disease level, imaging indicators of spondylolisthesis degree,the VAS score and ODI score before operation between the MIS group and open group(P > 0.05). The operation time, blood loss and radiological exposure time in operation, the drainage volume after operation were recorded in two groups.The VAS score and ODI were used for clinical assessment at preoperation, 1 months postoperation and last follow-up. The radiographic data were used to evaluate reduction of spondylolisthesis, including slipping degree, slipping angle, and intervertebral space height. The clinical effects were also analyzed by Macnab criterion at last follow-up. All patients accepted three-dimensional CT examination, the fusion rate was assessed by Suk criterion. The perioperative related parameters,and radiography index of two groups were compared and analyzed.Results No significant difference were found in operation time(105±15min and 95±10min) and radiological exposure time in operation(29±7s and 25±8s) between MIS and open group(P > 0.05), but blood loss(225±75ml and 550±150ml)in operation and drainage volume after operation(75±15 and 225±65ml) in MIS group were significantly less than those in the open group(P<0.05). Dural tear or cerebrospinal fluid leakage occurred in one patient of the open group,but no similar complication occurred in MIS group during operation;the pain of healthy leg occurs in one case of the open group after operation. There were two patients suffering incision infection,including 1 case in MIS group and 1 case in open group, and both the two patients were cured after conservative treatment; the other patients in two groups obtained primary healing of incision. All patients received 13-26 months follow-up(average, 19 months). In both two groups, the VAS score and ODI at 1 months postoperation and last follow-up is lower than those of preoperation(P<0.05); the slipping degree, slipping angle, and intervertebral space height at 1 months postoperation showed significant difference when compared with those of preoperation(P<0.05).The VAS score,ODI,the slipping degree, slipping angle, and intervertebral space height of the MIS group showed significant difference compared with those of the open group(P<0.05),but there were no statistical difference in ODI and VAS score at last follow-up between 2 groups(P > 0.05). At last follow-up, the lumbar spondylolisthesis all got good correction; no loosening, breakage, and displacement of pedicle screw and no cage dislocation occurred by X-ray films.According to Macnab criterion,the results of the MIS group and the open group were excellent in 20 cases and 21 cases, good in 29 cases and 25 cases, fair in 3 cases and 4 cases; the excellent and good rate was 94.2% and 92%(P>0.05). According to Suk criterion for fusion, 49 cases from MIS group and 48 cases from open group obtained complete fusion,3 cases from MIS group and 2 cases from open group got possible fusion,which showed no significant difference(P>0.05).Conclusion As long as indications are seized, MIS-TLIF assisted with microscope is safe and reliable for treatment of lumbar spondylolisthesis(Meyerding dergee I or II), and it has the advantage of less injury, less blood loss, less complications, and definite short-term effectiveness when compared with the open TLIF.