Clinical Efficacy Of Single-incision Wiltse Approach Combined With TLIF Of Fixed Diameter Channel

[Objective]Many people suffered lumbar degenerative diseases and their Quality of Life was affected.Lumbar interbody fusion surgery is the usual treatment for degenerative lumbar disease.At present,transforaminal lumbar interbody fusion(TLIF)is popular in clinical practice.The soft tissue damage in the traditional TLIF surgery is obvious,which affects the clinical results.We compare the traditional TLIF with the modified TLIF which means single-incision transforaminal lumbar interbody fusion assisted by fixed-diameter channel through Wiltse approach to discuss the advantages and disadvantages of modified TLIF surgery over traditional TLIF.[Methods]Between October 2016 and February 2013,47 patients with single segment lumbar degenerative diseases in the Department of Spinal Surgery of Cangzhou Central Hospital were enrolled according to the inclusion and exclusion standards.They are divided into two groups: the traditional group and the modified group according to the different working channel performed.24 patients were treated by traditional TLIF(traditional group),while the remaining 23 cases received single-incision transforaminal lumbar interbody fusion assisted by fixed-diameter channel through Wiltse approach(modified group).VAS scores of low back pain and leg pain,Creatine Kinase(CK),and ODI score were assessed before operation and after operation.The incision length,operation time,intraoperative blood loss,postoperative drainage volume,fusion effects and complications were recorded respectively and compared between the two groups.Forty-seven patients received complete follow-up.A retrospective controlled study was used and the data were analyzed by SPSS 23.0.[Results]1.Comparison during perioperative period.The average length of the surgical incision in the modified group(7.1 ± 1.52cm)was superior to that in the traditional group(9.3 ± 1.24cm)(P<0.05).The average blood loss in the modified group was better than that in the traditional group(104.3±36.02 ml VS 163.8±59.76ml)(P<0.05).The postoperative drainage volume in the modified group was 126.3 ± 58.71 ml,the traditional group was 364.2 ± 165.37 ml,the modified group was less(P<0.05).The postoperative creatine kinase value in the modified group(216.9 ± 104.38 U / L)was better than that of the traditional group(356.71 ± 215.46 U / L)(P<0.05).There were significant differences in the data above between the two groups.In terms of operation time,the average of the modified group was 96.4 ±28.87 min,while the average of the traditional group was 93.6 ± 22.51 min.there were no significant difference between the two groups(P>0.05).2.Comparison of postoperative clinical effects.The average VAS score and ODI score of the two groups decreased after operation,and the difference was statistically significant.Compared with the traditional group,the VAS score of the modified group was lower than that of the traditional group at 1 week,1 month,and3 months after surgery(P<0.05).There was no significant difference between the two groups.The ODI score of the modified group at 1 week,1 month,3 months,and6 months was also lower than that of the traditional group,the results were statistically significant.There was no significant difference in ODI score between the two groups at 12 months and 18 months after operation(P>0.05).It indicates that the single-incision transforaminal lumbar interbody fusion assisted by fixed-diameter channel through Wiltse approach is superior to the traditional TLIF in the short term after surgery.3.Comparison of fusion effects.Radiographic evaluation of interbody fusion was performed at 6 months after the operation,and the postoperative fusion was evaluated by the Simmons method.1 case of poor fusion was found in both groups.No progressive aggravation of low back pain was complained,no pedicle screw loosening or endplate defect was observed.The fusion rates were 95.8% in the traditional group and 95.6% in the modified group,respectively,showing no significant difference.[Conclusion]In spinal surgery,the classic method of TLIF is effective in treating lumbar degenerative diseases.Compared with posterior fusion of PLF and PLIF,the complication rate was lower,but its disadvantages are also unavoidable.Intraoperative soft-tissue destruction slows the progress of rehabilitation after surgery.The single-incision transforaminal lumbar interbody fusion assisted by fixed-diameter channel through Wiltse approach can significantly relief the symptoms in the short term after surgery without increasing the operation time,the number of fluoroscopy and postoperative complications,thus,providing surgeons and patients a more optimized treatment option.