| Objective:The explore feasibility,effectiveness,application value which is the combination of imaging CT-3D measures the volume of spinal canal and intraoperative neurophysiology monitoring in evaluating the effect of MIS-TLIF in lumbar spinal stenosis by analyze the correlation between spinal volume and motor evoked potentials changes.In order to make a reasonable and effectiveness evaluation of the operation performance of surgeon and the clinical curative effect,to a certain extent,it is of significance to assist decision-making and guidance.Methods: A retrospective study was performed on 70 patients with lumbar spinal stenosis who underwent MIS-TLIF in our hospital from August 2017 to February2019.All patients were monitored and recorded the amplitude data by intraoperative motion evoked potential(MEP),the volume of preoperative and postoperative stenosed spinal canal was measured by imaging CT three-dimensional reconstruction workstation,Oswestry dysfunction index(ODI score)and VAS score of waist were observed and followed up.The changes of 3D spinal canal volume,ODI,VAS and MEP amplitude before and after operation were compared.Correlation analysis was conducted between CT measurement results and MEP monitoring results and clinical efficacy ODI and VAS scores,respectively.Results:(1)The ODI scores were(23.23±6.40)and(4.27±3.89)before and 3 months after operation,There was significant difference in the groups before and after operation(P<0.05);(2)VAS scores before and 24 hours after surgery,7 days after surgery and 3 months after surgery were(6.38±0.98),(4.18±1.01),(2.73±1.19)and(1.51±0.82),respectively.The postoperative score of the waist was significantly lower than that before the operation,the difference between the two paired groups was statistically significant(P < 0.05);The score of 3 months after operation was lower than that of 7 days after operation;The average improvement rates of VAS in the waist were 34.21%,57.39%,76.92%,52.52%,70.65% and 76.12% before operation,24 hours after operation,7 days after operation and 3 months after operation,respectively;(3)Average preoperative spinal canal volume(4.93±2.98)cm3,average postoperative spinal canal volume(6.06 ± 3.19)cm3,average preoperative and postoperative spinal canal volume changes and improvement rates were 1.13cm3 and 26.79%,respectively.The difference in spinal canal volume between postoperative and preoperative was statistically significant(P < 0.05);(4)3D spinal canal volume change and improvement rate were correlated with the improvement rate of ODI score: r=0.663,P < 0.05;r =0.507,P < 0.05,and there was no correlation with the improvement rate of VAS score in each period of waist and leg.(5)The amplitude of MEP wave at left and right sides of L3,L4,L5,S1 was increased before and after decompression of spinal canal,and there was a significant difference in the amplitude,P < 0.05;The difference and change amount of the operation or non-operation side(heavy or light side),the difference and change amount of the left or right side,the change rate of the non-operation side,the change index of the operation or non-operation side(heavy or light side),the change rate and change index of the left side which was significant difference(P < 0.05);(6)The changes in 3D spinal canal volume were correlated with the changes in the MEP amplitude of the operative side of the operative segment: r=0.034,P=0.004.Conclusion: the evaluation indexes of 3D spinal canal volume,MEP amplitude,ODI and VAS in the patients were significantly improved compared with those before the operation.MIS-TLIF had a definite clinical effect in the treatment of lumbar spinal stenosis.3D vertebral canal volume and neural electrophysiology MEP monitoring method can effectively evaluate the clinical effect of surgical treatment,the joint in the MIS-TLIF evaluation of clinical efficacy in the treatment of patients with lumbar spinal stenosis disease is a kind of feasible and effective method,for performer in intraoperative operations without damage or reduce damage under the premise of the spinal cord or nerve,be fully complete and effective spinal canal decompression,and the decision to facilitate the surgical outcome can be made,which brings certain clinical guiding value. |
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