Comparative Mid-long-term Effectiveness Research Of Small Surgical Incision Process Versus Traditional Open Process In Posterior Lumbar Interbody Fusion

ObjectiveTo determine the mid-long-term effectiveness of small surgical incision process versus traditional open process in posterior lumbar interbody fusion, and evaluate the clinical application value of the small surgical incision process in posterior lumbar interbody fusion.MethodFrom march2006to august2007,79patients with lower lumbar degenerative diseases accepted posterior lumbar interbody fusion, which were randomly divided into two group:small surgical incision group (37patients)、traditional open group (42patients). After more than6years follow-up, the evaluation indicators including improvement of symptoms (low back pain visual analogue scale (VAS), Oswestry disability index (ODI)), lumbar vertebra biomechanics environment (intervertebral space height, segmental lordosis, lumbar lordosis), multifidus muscle cross-sectional area, mid-long-term complication (adjacent segmen degeneration (ASD), refractory low back pain, neurological symptom residual, internal fixation or interbody fusion failure, satisfaction rate and recommendation rate) were compared respectively between the two groups.ResultThe follow-up time was ranged from72to90months(average,80months). The follow-up rates for the two goups were78.4%(small surgical incision group,29/37) and71.4%(traditional open group,30/42). There were significant differences in postoperative low back pain visual analogue scale (VAS) and Oswestry disability index (ODI), lumbar lordosis change (the final follow up), multifidus muscle cross-sectional area change, mid-long-term complication rates and satisfaction rate and recommendation rate (p<0.05), but there were no statistically differences in operation segment intervertebral space height change and segmental lordosis change (P>0.05), there is no patient suffering from the internal fixation and interbody fusion failure during the follow up. further analysis about the relevant factors resulted in the differences of the mid-long-term complication rate between the two groups is as followed:both adjacent segmen degeneration (ASD) and refractory low back pain were related to operative blood loss, the time of postoperative lumbar muscle exercise, lumbar lordosis change and multifidus muscle cross-sectional area change; neurological symptom residual was related to operative blood loss, pre-operative low back pain visual analogue scale (VAS) and Oswestry disability index (ODI).ConclusionsCompared with traditional open process in posterior interbody fusion, the small surgical incision process had the advantage of smaller surgical incision, faster postoperative recovery, less multifidus muscle atrophy, less mid-long-term complication incidence and higher satisfaction rate and recommendation rate. Moreover, decreasing the operative blood loss, protecting multifidus muscle, persisting in the postoperative lumbar muscle exercise and maintaining lumbar lordosis may reduce the mid-long-term complication incidence.