Anatomical Study Of Modified Minimally Invasive TLIF And Comparison Of Clinical Curative Effect Under The Quadrant Channel

Objective: With the incidence of lumbar disc herniation increased year by year,Which causes the leg pain plaguing a growing number of middleaged patients。With the progress of aging society,lumbar disc herniation has become an important factor affecting the quality of people’s lives.It requires further surgery after conservative treatment.Conventional posterior lumbar interbody fusion TLIF is presented in 1940 s and used since then the most common surgical procedures,which is used as the treatment of lumbar disc herniation and lumbar spinal stenosis and other common diseases.The surgical approach to conventional incision,along spinous muscle stripping,pedicle screw will be driving at both sides of the adjacent vertebrae of the target lumbar disc.Parts of spinous and lamina are bited in order to expose fully surgical field.All those aims to removal of necrotic disc completely.Because of bilateral paraspinal soft tissue are dissected extensively and trauma,such surgery often leads to denervation and muscle atrophy.Because of bilateral paraspinal soft tissue are dissected extensively and trauma,such surgery often leads to denervation and muscle atrophy.It damage to the rear of lumbar structure and caused to the adhesion of endorachis and nerve root and low back muscle pain after surgery.The stability of the spine also decreased.Open surgery complications while minimally invasive surgery has become the main direction of the development of spinal surgery.Quadrant system(American Sofamor)retains the characteristics of minimally invasive surgery while what is closer to open surgery to learn and master easily.Minimally invasive TLIF Quadrant channel technology,which is wide range of application,a new generation of minimally invasive lumbar system developed and improved on the basis of TLIF.It can be applied in the surgical treatment of all of the lumbar degenerative diseases Including lumbar spinal stenosis,lumbar instability,lumbar spondylolisthesis and lumbar disc herniation.Surgery from patients with back experience the establishment of a "back channel expansion" which can the operator accurately reach the operation area.The surgery do not require extensive dissection muscle and soft tissue and realizing smoothly of the basic operation of traditional open surgery.Reducing muscle and fascia tissue destruction and conserving spinous processes on the basis of decompression to make the operation with less bleeding and small trauma.These methods effectively relieve postoperative pain,improve postoperative diet and sleep quality,accelerate the rehabilitation of patients after operation.In this study,through the comparative analysis of the operation indexes and clinical symptoms of patients to investigate the clinical efficacy of the Quadrant,the channel of minimally invasive TLIF and traditional open TLIF in the treatment of degenerative lumbar disease single gap.Methods: From January 2015 to June 2015,60 cases of lumbar spine L4-L5 single lumbar disc herniation,were randomly divided into three groups.The first group of 20 patients received conventional TLIF surgery.After the success of general anesthesia to take prone position,abdominal pad under the hollow cushion.The lesion intervertebral space as the center,take the waist after the median incision,about 7 ~ 10 cm.Followed by cut skin,subcutaneous,back fascia,careful coagulation to stop bleeding.Along the spinous process bilateral periosteum,electric knife cut the subperiosteal paraspinal muscle to bilateral lateral facet to reveal the operative field,C-arm X-ray pedicle screw implantation in the bilateral pedicle a total of four.Then the nerve root decompression stage standard TLIF operation,implantation of auto logous bone fragments and intervertebral fusion 1,after connecting rod fixation pedicle screw.After surgery is completed,saline cleaning wounds,placed negative pressure drainage,layer by layer stitching incision.The second group of 20 patients received conventional minimally invasive TLIF surgery.After the success of general anesthesia to take the prone position,C-arm accurate positioning to marker pen body surface markers.After routine disinfection bilateral incision routine disinfection of about 3cm,followed by incision of skin,subcutaneous,back fascia.Used intermuscular blunt separation after the gradual expansion of casing placed.Then placed the Quadrant minimally invasive channel,exposed lamina,facet joint and lamina gap,careful coagulation hemostasis.With a proprietary nucleus pulposus clamp in addition to channel soft tissue,bite in addition to the upper part of the lamina and medial facet.Separation of epidural space bite in addition to yellow ligament,exposing the dura mater,after the nerve root,the complete release of nerve root canal,removal of nucleus pulposus.With reed-level end-plate re-curette disc completely remove the disc tissue,fill the font fragments into the intervertebral space and pressure to the front of the intervertebral space.One piece of CAGE was implanted and a gelatin sponge was placed on the surface of the dura mater.The pedicle screws were implanted into the pedicle of the pedicle.In the navigator-assisted pedicle screw fixation rod,C-arm X-ray can be seen under good internal fixation.Surgery,exploration of the wound,to ensure that no active bleeding,placed negative pressure drainage,layer by layer stitching incision.The third group of 20 patients received modified minimally invasive TLIF surgery.The procedure of surgical anesthesia to place the minimally invasive is the same as the traditional minimally invasive TLIF procedure.After successful placement of the channel,the exposed lamina articular facet laminar space.In the channel under the bilateral pedicle screws were implanted 4,C-arm perspective position well after the screw out of the affected side of the two screws,and bone wax to seal the ball screw to stop bleeding.Operation of the exposed nerve roots,intervertebral disc removal CAGE implantation fusion is the same as the traditional minimally invasive TLIF.After CAGE implantation,the bone wax was removed from the ipsilateral nail and screwed into the pedicle screws,Bilateral minimally invasive channel on the connecting rod,C-arm fluoroscopy location of good fixation.After the operation,the wound was explored to ensure that there was no active bleeding and the incision was sutured tightly.60 cases of lumbar disc herniation in 33 males and 27 females,aged 24-68 years,mean 46.3 years.Three groups of indexes were compared by statistical analysis,including length of operation incision,operation time,blood loss,postoperative drainage volume,time of ground movement,postoperative hospital stay,visual analogue scale(VAS).Results: Compared with the traditional open TLIF surgery group,the traditional minimally invasive TLIF operation group and modified minimally invasive TLIF operation group were superior to the traditional surgery group.Including surgical incision length,bleeding volume,postoperative drainage,the activities of the time,postoperative hospital stay.Modified minimally invasive TLIF surgery group compared to the traditional minimally invasive TLIF surgery group,Visual analogue scale(VAS)scores were superior to those in the latter.Other indicators are basically the same.Conclusion: The improved minimally invasive TLIF via the Quadrant channel continues the advantages of the traditional TLIF over the open TLIF via the Quadrant channel.Further reducing the operation time and relieving the postoperative pain after perioperative treatment of lumbar disc herniation provides a new option for the Quadrant TLIF under the channel provides a new way of thinking.