Research Of The Anatomy,Imaging And Minimally Invasive Treatment Of Lumbar Spondylolisthesis Through Muscle-Splitting Approach

Objective To study the anatomy and related parameters of epidural, nerve roots,facet and adjacent structures through muscle-splitting approach.Methods 12 adult lumbar spine specimens were dissected through muscle-splitting approach to simulate minimally invasive procedure for the treatment of lumbar spondylolisthesis and research related anatomy of muscle-splitting approach and the scope of exposure. Distance between muscle gap and the midline, the angle between muscle gap approach and midline, distance of the bilateral facet vertex was measured. Surgical techniques of muscle-splitting approach were analyzed.Results Anatomical structures were exposed satisfactorily through muscle- splitting approach with minimal damage to the paraspinal soft tissue and bony structures. The average distance between paraspinal Wilste gap and the midline of L3/4, L4/5, LS/S1 was respectively 32.0mm, 35.1mm and 40.4mm.The distance between Wilste gap and midline of different vertebral levels was statistically significant(P <0.05). However, there was no significant difference among different genders regarding the distance between Wilste gap and midline(P > 0.05); The angle between muscle gap approach and midline of L3/4, L4/5 and LS/S1 was respectively 15.2 °, 15.8 ° and 17.3 °. The angles between muscle gap approach and midline of different levels were statistically significant(P <0.05),but there was no statistical significance among the angles between muscle gap approach and midline of different genders. The average distance of the bilateral facet vertex of L3/4, L4/5, LS/S1 was 29.7 mm, 34.0mm and 36.8mm, and the difference among different levels was statistically significant(P <0.05).Conclusion The muscle-splitting approach did preserve the interspinal ligaments and supraspinous ligaments, avoid excessive splitting paraspinal muscles, significantly reduce bleeding and damage to the posterior bony structures and soft tissues, and maintain spinal stability. Through muscle gap approach, it was easy to better protect nerve roots, reduce traction of spinal epidural, provide adequate surgical field for effective decompression of spinal canal and intervertebral foramen.Objective To investigate correlation between the MRI changes of fat infiltration in the lumbar multifidus muscles(LMM) and low back pain(LBP).Methods A retrospective study was carried out among 76 patients with LBP that was hospitalized between April 2010 and June 2014. Using MRI, the connection between the MRI changes of fat infiltration in the lumbar multifidus muscles and low back pain was analyzed. The relationship between multifidus muscle fat infiltration and age, duration of low back pain, disc degeneration and lesion segment were estimated using logistic regression analysis.Results 73 patients with fat infiltration was noted in all subjects, accounting for 96 % of all patients. Fat infiltration ratio of the lumbar multifidus muscles was linked to lumbar segment. Fat infiltration ratio of L5-S1 segment was more than that of L4-5. Meanwhile, fat infiltration ratio of L4-5 segment was more than that of L3-4, and statistical differences were significant(P<0.01).Fat infiltration ratio of the LMM was positively connected with age. Fat infiltration ratio of the LMM increased when duration of low back pain was more than 12 months or older than 40.Conclusion Fat infiltration in the LMM is strongly associated with LBP in patients. Evaluation of fat infiltration in the LMM is helpful to the therapy and management of LBP.Objective To analyze microsurgical treatment of minimally invasive transforaminal interbody fusion(MIS-TLIF) through Wiltse approach for spondylolisthesis.Method Between May 2012 and November 2013,13 patients diagnosed lumbar spondylolisthesis(Myerding Grade Ⅰ ~ Ⅱ) were included. With the assistant of neurophysiological monitoring and microscope, all patients were treated by MIS-TLIF through Wiltse approach(gap between the multifidus and the longissimus). Operation time, blood loss, postoperative wound pain duration and Lumbocrural pain relief time were analyzed. Creatine phosphokinase(CPK-MM) level was recorded preoperatively, 1 day, 3 days and 7 days postoperatively. Japanese Orthopaedic Association(JOA)score and visual analog scale(VAS) score were analyzed preoperatively,1 week,3 months and 6 months postoperatively. X-ray examination and MR imaging of lumbar spine were achieved preoperatively and 6 months postoperatively to assess slippage reset and nerve decompression. Lumbar CT three-dimensional reconstruction was used to confirm pedicle placement and spinal stability.Results All patients accepted successful operation without nerve injury. The blood loss was 185.3 ± 26.3ml, and operating time was 186.0 ± 23.0min. Postoperative lumbar X-ray examination and MRI scan demonstrated good slippage reset and complete nerve decompression. Postoperative lumbar CT three dimensional reconstruction showed accurate pedicle placement and good spinal stability. VAS, JOA score obviously improved in postoperative 1 week, 3 months and 6 months compared with that before operation. CPK- MM level peaked at postoperative 1 day, then gradually reduced, and almost descended to preoperative level at postoperative 7 day.Conclusion MIS-TLIF technique has obvious advantages over operating time, blood loss, paraspinal muscle protection and improvement of clinical symptoms. It is feasible and clinically effective of MIS-TLIF through Wiltse approach for lumbar spondylolisthesis with the assistance of microscope and neurophysiological monitoring.