A Comparative Study On The Early Clinical Efficacy Of Extreme Lateral Interbody Fusion And Posterior Lateral Interbody Fusion In The Treatment Of Lumbar Spondylolishthesis

Obejects:To compare and study of the early clinical efficacy of Extreme lateral interbody fusion(XLIF)and Posterior lateral interbody fusion(PLIF)in the treatment of lumbar spondylolisthesis.Methods:Reviewed and summarized 32 cases with lumbar spondylolisthesis in our department from April 2018 to October 2019.Including 16 cases in XLIF combined with the under-channel multifidus muscle approach predicle srew fixtion in lateral decubitus position treated a single-level lumbar spondylolisthesis(Minimally invasive group),16 patients in PLIF(Open group).Recorded informations about patients of both group of age,genders,disease durations,lesion segments,preoperative view analog scales scores(VAS),Oswestry disability indexs(ODI)and preoperative Image Features.Summarized dates of operation time,hospitalization time,blood loss,fluoroscopy times in patients of two groups.Counted the incidences of postoperative complications within 30 days after surgery in two groups.Collected 5ml venous blood samples for C-reactive protein(CRP)and Creatine Kinase(CK)on preoperative 1 day and at postoperative 12 hours,24 hours,48 hours.Evaluted the clinical efficacy respectively on postoperative 7 days,3 months,6 months,12 months after the operation and the last follow-up by the visual analogue scale scores(VAS)and oswestry dysfunction indexs(ODI).And reexamined X-ray and Magnetic Resonance Imaging(MRI)of the lumbar spine,measured the foraminal height,disc height,the transverse diameter dural sac and observed its image features at the same time.Evaluated the recovery of lumbar function by the modified MacNab scores.Result:1.There were no statistically significant differences in the general conditions of age,genders,disease durations,lesion segments,preoperative visual analogue scale scores,Oswestry disability indexs and preoperative Image Features between the two groups(P>0.05).The patients in two group had comparable.2.Compared the incidences of complications within 30 days after surgery in the two groups,the minimally invasive group was 25%(4/16)and the open group was 31.4%(5/16).The difference was no statistically significant(P> 0.05).3.Minimally invasive group had decreased blood loss,short hospital stay,increased operative time and more fluoroscopy times compared with open group in treating single-segment lumbar spondylolisthesis.The difference was statistically significant between two groups(P< 0.05).Compared with preoperative CRP and CK indexes between two groups,there was no statistically significant difference(P<0.05).The patients in two group had comparable.The CRP and CK indexes in the minimally invasive group(MIS-group)was lower than the open surgery group(OS-group)(P<0.05).The VAS scores of the MIS-group was better than the OS-group on postoperative 7 days,3 months and 6 months(P<0.05).The ODI scores of the MIS-group was better than the OS-group on postoperative 7 days,3 months,6 months,12 months and the last follow-up(P<0.05).4.The change of foraminal height,disc height in the MIS-group increased significantly compared the OS-group on postoperative 7 days,3 months,6 months,12 months(P<0.05).The change of the Anteroposterior dural sac diameter in the MIS-group increased significantly compared the OS-group at postoperative 7 days,3 months,6 months,12 months and the last follow-up(P< 0.05).According to modified MacNab standard:The excellent rate in the minimally invasive group was 93.75%,the excellent rate in the open surgery group was 87.50%,and the difference was no statistically significant(P>0.05).Conclusion: The treatment of lumbar spondylolisthesis with XLIF combined with the under-channel multifidus muscle approach predicle srew fixtion in lateral decubitus position is effective and feasible.Compared withe PLIF,XLIF had distinct advantages of less blood-loss,less tissue trauma,better effect of decompression,faster recovery and to be worth spreading.