Intraoperative Nerve Root Block After MIS-TLIF Combined With No Drainage To Optimize The Postoperative Efficacy In The Treatment Of Lumbar Disc Herniation

Objective: Study of gelatin sponge impregnated mixed analgesic drugs for nerve root block combined with no drainage after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)to optimize postoperative effect in the treatment of lumbar disc herniation(LDH),and to explore the possibility of promoting early postoperative rehabilitation for patients with LDH.Methods: From June 2018,under the successful register of clinical research program in advance,the middle-aged patients(45-60 years old)with LDH and surgical indications were recruited at the spine center of Xi’an Hong Hui Hospital.Finally,48 patients were included in the study and were treated with MIS-TLIF surgery after screening according to inclusion and exclusion criteria.No drainage tube was placed after surgery.All included patients signed the informed consent of the clinical trial before surgery,and who agreed to sign were distributed to the intervention group(Gelatin sponge impregnated with mixed analgesic drugs for intraoperative nerve root block,24 cases),patients who disagreed with the signature were included in the control group(Saline was immersed in gelatin sponge as a control,24 cases).The VAS of lower back pain and leg pain at the pre-operation and postoperative day 1-10 in the two groups were compared.The length of bed rest and postoperative hospital stay were observed.The collection of secondary outcome data included the results of the Japanese Orthopaedic Association Scores(JOA)at the preoperation and postoperative third day and sixth day;postoperative satisfaction questionnaire results;clinical efficacy evaluation results based on JOA scores sixth day after surgery;complications.The differences related to postoperative rehabilitation,patient’s satisfaction,and complications between two groups were analyzed.The relevant clinical data were uniformly analyzed by statistical software SPSS 20.0.The t test was used for continuous variables,which value was expressed as mean ± SD.For enumeration data,the chi-square test was used.The significance level is set to α = 0.05.Results: All patients completed follow-up.There was no significant difference in the demographic data between two groups(P>0.05).The incidence of postoperative nerve root edema in the control group was 45.8%,which was significantly higher than that in the intervention group(P=0.029).The hospital stays(5.6±0.8 days)and bed length(2.4±0.5 days)in the intervention group were significantly lower than those in the control group(7.2±1.4 days,3.1±0.6 days),and the difference was statistically significant(P<0.05).The VAS score of low back pain in the intervention group was significantly lower than that of the control group at 1-6 days after operation,and the difference was statistically significant(P<0.05,for all).The VAS scores of leg pain in the intervention group at 1-7 days after surgery were statistically lower than the control group(P<0.05,for all).The JOA score(19.3±2.8)at sixth day in the intervention group was significantly higher than that in the control group(P=0.024).The satisfaction rate was 100% in the intervention group and 87.5% in the control group,but there was no statistical difference between two groups(P>0.05).The results of clinical efficacy evaluation based on the JOA score of sixth day after surgery showed that the significant effective rate of the intervention group(45.8%)was higher than that of the control group(33.3%),but there was not statistically significant(P>0.05).Four patients(16.6%)in the intervention group had postoperative adverse reactions.Three of them(12.5%)had different degrees of bilateral limb muscle weakness after operation,lasting 5-10 hours,with an average of 6.7±3.1 hours,but full recovery within 24 hours.One patient(4.2%)developed headache and vomiting.One case(4.2%)of the control group developed postoperative infection.Both groups were examined by CT,without fracture or displacement of pedicle screws and titanium rods,and no deaths.Conclusion: Application of gelatin sponge impregnated mixed analgesic drugs to nerve root block combined with no drainage after MIS-TLIF can significantly reduce short-term pain of low back pain and leg pain,and further optimize the surgical effect of LDH and promote patient’s early exercise,shorten the bed and hospital stay,to achieve the purpose of early rehabilitation.