Impact Of Intrasacrospinal,muscular Approach Or Midline Approach On Paraspinal Muscle During Lumbar Interbody Fusion: A Meta-analysis

Objective Evidence-based meta-analysis was used to evaluate the effect of traditional posterior median lumbar vertebral fusion and paraspinal interbody approach lumbar fusion on paravertebral muscle injury.Methods The computer searches Pub Med,CNKI,Wanfang and VIP databases.Search keywords such as "paraspinal intermuscular approach","intermuscular approach" and "posterior lumbar interbody fusion" or "posterolateral lumbar fusion",and use keywords and free words to search manually.From the establishment of the database since August 2017,domestic and foreign related to the more traditional posterior median approach and paraspinal muscle approach for the treatment of lumbar degenerative lesions of the latest clinical studies related literature.And read one by one,after excluding the irrelevant literature of this topic,the extraction of surgical time,intraoperative bleeding,postoperative drainage,postoperative hospital stay,postoperative complications and other relevant data.After extracting valid data,Sata12.0 statistical software was used for meta-analysis.Results A total of 12 articles were included in the study.A total of 928 patients were included.457 patients underwent posterior lumbar fusion(PLF group)for paraspinal muscle approach and 471 patients underwent traditional posterior lumbar interbody fusion(PLIF).The combined results showed that compared with the PLIF group,the PLF group had less intraoperative blood loss(WMD:-2.262 ml,P = 0.000)and less postoperative drainage(WMD:-2.885 ml,P = 0.000),and decreased postoperative concurrent The disease(OR: 1.89,P=0.058),and shortened postoperative hospital stay(WMD:-0.93 d,P=0.000)and operative time(WMD:-0.645 min,P=0.000).Conclusion In general,paraspinal intermuscular approach lumbar fusion is safe and effective.It can reduce intraoperative bleeding,postoperative drainage,reduce postoperative complications,shorten hospital stay and operation time,and accelerate patient recovery.But at the same time it also needs to have a deeper understanding of the anatomy of the operator and the degree of surgical proficiency.It is more difficult to get started than after the middle approach.The Wiltse approach does not apply to lumbar degenerative diseases with bilateral nerve root compression symptoms,and severe lumbar spinal stenosis requiring full laminectomy does not apply.