| Objective: To analyze and explore the method,clinical efficacy and safety of double small incision TLIF(MIS-TLIF)in the treatment of lumbar degenerative diseases,and compare it with traditional open TLIF to provide better minimally invasive surgery for the treatment of lumbar degenerative diseases.Methods: Retrospectively,from October 2018 to January 2020,70 patients with lumbar degenerative diseases treated in spinal surgery department of Dalian Central Hospital were divided into minimally invasive group(double small incision TLIF)and open group(O-TLIF),The follow-up time is greater than 12 months.There were 30 cases in the MIS group(15 male,15 female),with an average age of 56.50±13.44 years(23 to 82 years),and an average BMI of 25.09±2.53.Disease classification: lumbar disc herniation with lumbar instability(18 cases),lumbar spondylolisthesis(5 cases),lumbar spinal stenosis(7cases).Operation location: L4/L5 8 cases,L5/S1 10 cases,L3/L5 2 cases,L4/S1 10 cases;There were 40 cases in the open group(19 male,21 female),with an average age of60.08±12.89 years(24-80 years),and an average BMI of 26.45±4.23.Disease classification: lumbar disc herniation with lumbar instability(22 cases),lumbar spondylolisthesis(8 cases),lumbar spinal stenosis(10 cases),operation location: L4/L5 12 cases,L5/S1 4 cases,L3/L5 3 cases,L4/S1 21 cases.Record and compare the overall length of the incision,blood loss,operation time,intraoperative fluoroscopy time,incision drainage,postoperative bed time and postoperative hospital stay in the two groups.The VAS score and ODI score of low back and leg pain were evaluated preoperatively and postoperatively at the time of 1,6,12 months.LL was recorded and compared before,after operation,and at the last follow-up.At 12 months after operation,the surgical segmental fusion was evaluated according to the lumbar lateral X-ray.Results: All patients were followed up for more than 12 months.In the minimally invasive group,the total incision length was 6.63±0.72 cm,the intraoperative blood loss was 93.0±63.55 m L,the incision drainage volume was 87.17±50.70 m L,the postoperative bed time was 42.37±16.23 h,and the postoperative hospital stay was 4.17±0.79 d,the data were significantly reduced compared with the open group(total incision length8.19±1.14 cm,intraoperative blood loss 445.0±329.30 m L,incision drainage volume592.0±285.79 m L,postoperative bed time 83.13±17.88 h,postoperative Hospitalization time 5.83±1.47d(P<0.01).The operation time of the minimally invasive group was159.17±45.77 min,which is shorter than open group(135.52±34.82min)(P<0.05);The intraoperative fluoroscopy time of the minimally invasive group was 34.53±8.02 s,which was longer than that of the open group(20.10±6.10s)(P<0.01).The preoperative VAS-B,VAS-L and ODI scores were not different between the two groups of patients(P>0.05).The pain of lumbar and legs and lumbar function had significantly improved postoperatively in the two groups of patients.The scores of VAS-B,VAS-L and ODI in each group of patients were significantly lower than those before operation at 1,6,12 months after operation,and the difference was significant.The VAS-B score of the minimally invasive group improved more significantly at 1 and 6 months after the operation than the open group(P<0.05).There was no significant difference between the two groups at 12 months after the operation.There was no significant difference in VASL and ODI scores between the two groups of patients at 1,6,and 12 months after surgery(P>0.05).The preoperative LL difference between the two groups was not significant(P>0.05).The postoperative LL improvement of the open group was better than that of the minimally invasive group(P>0.05).In the minimally invasive group,1 patient experienced dural rupture and cerebrospinal fluid leakage after surgery,which was cured after conservative treatment.1 patient developed skin necrosis of the decompression side incision,no deep tissue infection occurred.In the open group,1 patient developed cerebrospinal fluid leakage after surgery,and 1 patient had liquefaction of fat in the incision.There were no misplacement of pedical screws,large blood vessel damage,or nerve root damage in both groups.During the follow-up,there was no loosening or displacement of implants in the two groups of patients,no endplate collapse occurred,and all the patients achieved bony fusion in the surgical segment.Conclusion: Double small incision TLIF surgery has a definite clinical effect and can achieve similar clinical efficacy as traditional TLIF surgery.At the same time,it has the advantages of small overall length of incision,more aesthetic incision,less surgical trauma,less intraoperative bleeding,faster postoperative recovery,and shorter hospital stay.Double small incision TLIF uses freehand screw placement through tubular retactor and sequential screw/rod insertion technology to reduce the length of intraoperative fluoroscopy and reduce the radiation exposure of the surgeon and patient;double small incision TLIF takes longer and more stringent Indications for surgery. |
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