Comparison Of The Effect Of Anterior Intervertebral Space Expansion With Or Without Fusion Cage In TLIF On Patients With Lumbar Disc Herniation

Objective: To compare the clinical effect of intervertebral space expansion before fusion cage implantation in TLIF.Methods: 64 patients with L4 / 5 disc herniation who were treated by TLIF from June 2013 to June 2018 in the orthopedics department of Cangzhou central hospital were analyzed retrospectively.According to the different operation methods,they were divided into two groups:the distraction group and the non-distraction group.Through observing the clinical therapeutic effect(JOA,ODI score)and measuring the imaging indexes,we compared the effect of the open group on the intervertebral space.The influence of the height of intervertebral foramen and the angle of lumbar lordosis on the clinical efficacy.Results:There were 30 cases in the distraction group and 34 cases in the non-distraction group.The follow-up period was 6-24 months,with an average of(15.0±5.3)months.There was no significant difference in gender,operative age,operative time,peroperative bleeding and hospitalization time between the two groups(P>0.05).In the follow-up at different times after the operation,the JOA score,ODI score and other clinical indicators in the two groups were significantly improved,and there were statistical differences(P<0.05).In the comparison of JOA scores at different times and ODI scores at 6 months after operation,the improvement of intervertebral space distraction group is more significant than that of non-distraction group,and there is a statistical difference(P<0.05).There was a significant increase in L4/5 intervertebral space and intervertebral foramen height between the two groups.The measured values of intervertebral space distraction group at different times after operation were significantly improved than those of non-distraction group,and there were statistical differences(P<0.05).During the follow-up period,2 patients with nerve root stimulation symptoms occurred in the intervertebral space unstretched group.The lumbar spine anteroposterior examination found 1 patient with intervertebral Cage position shift and the other 1 patient with Cage fracture,which were all relieved by surgical revision.Conclusions:1.In TLIF,there is no statistical significance in sex selection,operation age,operation time,intraoperative blood loss and hospitalization time for comparing intervertebral space distraction and non-distraction,suggesting that distraction of intervertebral space as much as possible under the condition allows will not cause greater surgical trauma.2.Both distraction and non-distraction of intervertebral space in TLIF can achieve satisfactory clinical effects for patients with single-segment lumbar disc herniation.3.The intervertebral space distraction group has the advantages of intervertebral space,intervertebral foramen height closer to physiological height,more thorough and smooth removal of nerve root compression,better clinical effect,fewer postoperative complications,etc.