| Objective:To analyze the clinical outcomes and security of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) with unilateral pedicle fixation for lumbar degenerative diseases.Methods:From March 2013 and March 2014,38 patients with lumbar degenerative diseases were treated through MIS-TLIF with unilateral pedicle fixation, including 21 males and 17 females, aged from 38 to 72 years(average,55 years). All the 38 cases were single-level desease, including 22 cases of L4,5,9 cases of Ls-si and 7 cases of L3,4. The operation time, blood loss, postoperative drainage and complications were recorded. The pre- and post-operative clinical outcomes were assessed by visual analogue scal(VAS) and Japanese Orthopaedic Association Scores(JOA).Thin-layer helical CT scanning reconstruction was used to evaluate the fusion rate and cage cutting. X-ray film of lumbar vertebra AP & LAT was used to evaluate the intervertebral space height, the internal fixation position.Results:The operation time was 55-95 minutes(mean,70 minutes); blood loss was 85-205 ml(mean,115 ml); and postoperative drainage volume was 20～70 ml(mean,40 ml). The wounds of 37 patients healed by first intention while 1 case was local cutaneous necrosis around the incision and the healing condition was satisfactory after wound dressing; dural laceration occurred in 2 case during operation while the wound remained unstitched and leakage of cerebrospinal fluid (CSF) was not observed at the incision; nerve root injury did not occur during the operation. All the patients were followed up from 18 to 24 months(average 20 months). VAS score of low back pain and leg pain from preoperative (5.8±1.1), (7.2±1.6) to (3.1±1.3), (3.0±1.4) at 7th day after operation and (2.0±1.1), (2.1±1.2) at the final follow-up. There were significant difference before after operation and the final follow-up (both P<0.05). JOA scores from preoperative(8.6±1.4)to (22.5±1.4)at 3 months after operation and (25.2±1.8) at the final follow-up. And 28 cases were evaluated as excellent,7 cases as good,3 cases as average, and the excellent and good rate was 92.1%. the intervertebral space height from preoperative (9.4±1.5) mm to (11.1±1.4) mm at 7th day after operation and (10.9±1.3) mm at the final follow-up. The difference of intervertebral space height before and after operation presented statistical significance (P<0.05) while the difference between 7th day after operation and the final follow-up presented no statistical significance (P>0.05). the fusion rate of bone grafting during the final follow-up was 86.8% and Cage cutting endplate was found in 6 cases. Internal fixation looseness, fracture was not detected.Conclusion:MIS-TLIF with unilateral pedicle fixation was safety. The clinical outcomes was satisfied.In addition, it has the advantage of high fusion rate, less trauma,quicker recoverer,cost-effectiveness and convenience. However, the indications of operation require strict control and the long-term curative effect remains to be examined in further clinical studies. |
PDF Full Text Request