| Objective : To explore the clinical efficacy and safety of full endoscopic minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar 4-5disc herniation with lumbar instability.And compared with the expandable channel MIS-TLIF,to further clarify the advantages of full endoscopic MIS-TLIF.Methods :A retrospective analysis of the clinical data of 38 patients with lumbar 4-5disc herniation with lumbar instability treated from the Department of Orthopedics in Gansu Provincial People’s Hospital from October 2016 to March 2019.The full endoscopy MIS-TLIF was used as the endoscopy group(18 cases),including 10 males and 8 females,aged 41-77 years,with an average age of(60.00±10.44),and a disease course of 0.5-8 years,with an average(2.75±1.87)year.Preoperative low back pain VAS score(6.88±1.07),leg pain VAS score(5.88±0.95),ODI index(53.52±6.12)%.The expandable channel MIS-TLIF was used as the channel group(20 cases),including 11 males and 9 females,aged 31-79 years,with an average age of(58.25±11.89)years,with a disease course of 1-8 years,average(3.18±1.76)Years,preoperative low back pain VAS score(7.06 ± 0.98)points,leg pain VAS score(5.83 ±0.89)points,ODI index(53.79±5.77)%.The perioperative observation indexes,surgical efficacy evaluation indexes(back pain VAS score,leg pain VAS score,ODI index),serum creatine kinase(CK),intervertebral space height and intervertebral fusion were compared and analyzed.Results :All patients were followed up for 12-24 months.The operation time(163.33±12.37)min and the number of fluoroscopy(53.11±13.50)in the endoscopic group were greater than those in the channel group,and the difference was statistically significant(P<0.05).Endoscopic group intraoperative blood loss(104.44 ± 28.74)ml,postoperative drainage volume(80.00 ± 14.95)ml,analgesic drug dosage(144.44 ± 61.57)mg,postoperative ground time(20.50±5.42)h,total hospitalization the time(6.81±1.23)d was less than the channel group,and the difference was statistically significant(P <0.05).The VAS score of low back pain in the endoscopic group was lower than that in the channel group at 1week(3.87±0.85)and 3 months(1.41 ± 0.77)after operation(P <0.05).The VAS score of leg pain in the endoscopic group was lower than that in the channel group at 1 week(2.09±0.821)(P <0.05),and there was no significant difference between the two groups at 3 months and 12 months(P> 0.05).The ODI index(24.64 ± 4.27)% of the endoscopic group was significantly lower than that of the channel group at 3 months after surgery(P <0.05),and there was no significant difference between the two groups at 12 months after surgery(P>0.05).According to the MacNab standard at 12 months after surgery,the excellent and good rate of the endoscopic group(94.44%)was higher than that of the channel group(90%),but the difference was not statistically significant(P> 0.05).The serum CK value(355.46 ±53.30)U / K of the endoscopy group was lower than that of the channel group(417.55 ±87.22)U / K the next day after surgery,and the difference was statistically significant(P<0.05).There was no significant difference in the height of the intervertebral space between the two groups at 12 months after operation(P> 0.05).According to the Brantigan-Steffee intervertebral fusion standard at 12 months after surgery,the two groups of patients had achieved successful fusion,and the difference was not statistically significant(P> 0.05).One patient in the endoscopic group experienced numbness in the lower leg after surgery.Considering the nerve root stimulation or injury during the operation,the symptoms gradually disappeared within 1 week after symptomatic treatment.In the channel group,1 case was delayed healing due to exudation of the incision,and 1 case was cured after cerebrospinal fluid leakage and drainage.Conclusion : Full endoscopy MIS-TLIF is safe and effective for the treatment of lumbar 4-5 disc herniation with lumbar instability,and can achieve the same clinical efficacy as the expandable channel MIS-TLIF.Compared with the expandable channel MIS-TLIF,the full endoscopic MIS-TLIF has less trauma,less postoperative pain,earlier postoperative time to move to the ground,shorter hospital stay and faster postoperative recovery. |
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