| Objectives:The purpose of this research is to explore and discuss the clinical effects of MIS-TLIF(via zista channel)in the treatment of multi-level lumbar degenerative diseases(LDD),and to compare with the traditional open transforaminal lumbar interbody fusion(open TLIF),also to evaluate the advantages and disadvantages between MIS-TLIF and open TLIF,analyzing its effectiveness and safety.Methods:A total of 126 patients who underwent multi-level lumbar degenerative disease and have had lumbar interbody fusion in our hospital from January 2016 to June 2018 were retrospectively analyzed.They were divided into two-level minimally invasive group,two-level open group,three-level minimally invasive group and three-level open group.Among them,there were 90 cases in two-level group,including 50 cases of minimally invasive group,which has 24 males and 26 females,aged 50~88 years old,with an average of 64.8 years old;40 cases of open invasive group,which has 16 males and 24 females,aged 58~79 years old,with an average of66.3 years old;36 cases in the three-level group,including 17 cases of minimally invasive group,which has 9 males and 8 females,aged 60~74 years,with an average of 64.7 years old;19 cases of open invasive group,which has 9 males and 10 females,aged 50~68 years,with an average of 62.0 years old.The differences between the minimally invasive group and the open group both in the two-level and three-level groups were compared between the operation time,the intraoperative bleeding volume,the postoperative drainage,the first time to get out of the bed and the postoperative time of the hospitalization.VAS and ODI were used to evaluate the clinical outcomes.The internal fixation devices and fusions were evaluated based on the reviewed X-ray after hospitalization.Results:There were no significant differences between the minimally invasivegroup and the open group both in the two-level and three-level groups in terms of gender,age,fusion segment,operation time,preoperative lower back pain VAS score,lower limb pain VAS score and ODI score(P > 0.05).The intraoperative bleeding volume: two-level minimally invasive group 292.4±174.6ml,two-level open group600.0±297.4ml,three-level minimally invasive group 435.7±217.4ml,three-level open group 961.1±303.9ml(P < 0.05).The postoperative drainage volume: two-level minimally invasive group 85.2±38.0ml,two-level open group 347.7±87.4ml,three-level minimally invasive group 111.3±31.2ml,three-level open group465.0±114.2ml,the difference is statistically significant(P < 0.05).The first time of postoperative ambulation: two-level minimally invasive group 0.9±1.0d,two-level open group 4.8±2.7d,three-level minimally invasive group 2.2±0.4d,three-level open group 6.2±4.0,the difference is statistically significant(P < 0.05).The postoperative time of the hospitalization: two-level minimally invasive group 4.7±2.3d,two-level open group 14.5±6.7d,three-level minimally invasive group 6.7±1.6d,three-level open group 16.8±8.5,the difference is statistically significant(P < 0.05).Two weeks and three months postoperative lower back pain VAS: two-level minimally invasive group 3.3±0.5&2.3±0.7,two-level open group 3.9±0.6&3.0±0.7,the difference is statistically significant(P < 0.05).Three months postoperative lower back pain VAS:three-level minimally invasive group 2.3±0.8,three-level open group 3.1±0.4,the difference is statistically significant(P < 0.05).The VAS of lower back pain and lower limb pain both in the minimally invasive group and the open group in the two-level and the three-level groups were lower than those of preoperative VAS.All the differences are statistically significant(P < 0.05).In the two-level minimally invasive group,there were 3 cases of complication,including 1 case of cerebrospinal fluid leakage caused by sac rupture,1 case of incision delayed healing,1 case of lower limb muscle strength decreased after operation.In the two-level open group,there were 5 cases of complication,including3 cases of cerebrospinal fluid leakage caused by sac rupture,1 case of incision delayed healing,1 case of lower limb muscle strength decreased after operation.There were 2 cases of complication in the three-level minimally invasive group,3cases of complication in the three-level open group,all these are cerebrospinal fluid leakage caused by sac rupture.All cases were followed up after operation.The position of the interbody cage was fixed and there was no displacement.The anterior and lateral vertebral bridges were connected,and there were continuous trabecular bones in the intervertebral space.No segmental translucent shadow,no bone graft sinking,no gaps between the endplate and bone graft,also no damage,looseness or displacement of the internal fixation device.Conclusions:MIS-TLIF treats multi-level lumbar degenerative diseases,which can achieve the same effect and bone graft fusion as open TLIF.It has less intraoperative bleeding,less postoperative drainage,the first time of postoperative ambulation is early,postoperative time of the hospitalization is short,the symptoms of lower back pain are improved in the short term after surgery and the complications are less. |
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