| ObjectivesParaspinal mini-tubular lumbar decompression(PMTD)technique and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)technique both have been widely used in the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis,but both have their own advantages in surgical methods and surgical concepts.Regarding PMTD and MIS-TLIF techniques,there is no relevant research report on the best surgical indication in the degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis.The purpose of this study is to retrospectively collect relevant clinical outcome data of patients with degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis treated with PMTD or MIS-TLIF,and to explore the efficacy of PMTD and MIS-TLIF for the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis.MethodsWe retrospectively collected relevant clinical outcome data of patients with degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis who were treated with PMTD or MIS-TLIF at the department of Neurosurgery,Fujian Medical University Union Hospital from September 2017 to March 2020.The follow-up period was 1 year after surgery.Comparing the age,BMI,smoking history,underlying diseases(hypertension,diabetes,etc.),ASA grade of anesthesia,diseased segment,clinical manifestations,duration of symptoms,relative slip distance of vertebral body,preoperative Oswestry disability index(ODI)score,preoperative leg pain visual analogue scale(VAS)score,and preoperative low back pain VAS score,the results were determined to be comparable between the two groups.PMTD group and MIS-TLIF group were compared in terms of surgery-related indicators,the improvement of the VAS score of leg pain 1 year after the operation,the improvement of the VAS score of the low back pain 1 year after the operation,and the improvement of the ODI score 1 year after the operation.Descriptive statistics are reported as mean,standard deviation,frequency and percentage.When comparing the two groups,the measurement data are expressed as the mean±standard deviation.When the data population obeys the normal distribution,the independent sample t test is used.If the data population does not obey the normal distribution,the non-parametric test(Wilcoxon rank sum test)is used;The count data was analyzed by X~2 test,and when P<0.05 was considered to be statistically significant.All data analysis was performed using SPSS 25.0.ResultsA total of 104 patients with degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis were included in this study.There were 53 patients in the PMTD group and 51 patients in the MIS-TLIF group.The average age of the PMTD group was 62.06±13.62 years,and the proportion of men was 50.9%(27cases);the average age of the MIS-TLIF group was 59.94±8.28 years,and the proportion of women was 66.7%(34 cases).Between PMTD group and MIS-TLIF group,the differences of age,sex ratio,BMI,smoking history ratio,comorbidity ratio,ASA III ratio,symptom duration,relative sliding distance of vertebral body,preoperative VAS score and preoperative ODI score were not statistically significant(P>0.05).The operation time,intraoperative blood loss,surgical incision,postoperative hospital stay,and total hospitalization expenses in the PMTD group were significantly less than those in the MIS-TLIF group(P<0.001).There was no significant difference in the VAS score of leg pain at 1 year after operation and the VAS score of low back pain at 1 year after operation between the PMTD group and the MIS-TLIF group(P>0.05);and comparingΔVAS score of leg pain andΔLow back pain between the two groups,there was no significant difference in the comparison of VAS scores.The ODI score at 1 year after operation of the MIS-TLIF group was lower than that of the PMTD group,and the difference was statistically significant(P<0.05);however,there was no significant difference in theΔODI score between the PMTD group and the MIS-TLIF group(P>0.05).There was no significant difference between the PMTD group and the MIS-TLIF group in the incision infection rate,fat liquefaction rate,reoperation rate,and postoperative lumbar instability rate(P>0.05).Conclusions(1)PMTD and MIS-TLIF have a significant effect on the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis,which can significantly improve the pain and functional status of the patient one year after surgery.(2)There was no significant difference in improving the degree of pain and functional status of patients 1 year after surgery between PMTD and MIS-TLIF.(3)PMTD and MIS-TLIF in the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis,there is no significant difference in the incidence of lumbar spine instability 1 year after surgery.(4)Considering the degree of pain,the improvement of functional status,and hospitalization costs,PMTD is expected to become a routine choice for patients with degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis. |
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