Comparison Of The Efficacy Of PE-TLIF And MIS-TLIF In The Treatment Of Degenerative Lumbar Spinal Stenosis

Background and ObjectiveDegenerative lumbar spinal stenosis is one of the most common spinal surgical diseases in clinical work.At present,the incidence of this disease has been increasing,and it has been developing at a young age.The main manifestations of degenerative lumbar spinal stenosis are Lumbago and leg pain,intermittent claudication,which affect people’s daily life and work.Conservative treatment is generally effective for early or mild to moderate patients,but for severe or ineffective conservative treatment,surgery is often needed to achieve more satisfactory results.At present,there are many kinds of surgical methods for degenerative lumbar spinal stenosis.With the development of medical technology,surgical methods have gradually developed from traditional open surgery to minimally invasive surgery,contemporary Spinal surgeons are constantly working on more minimally invasive treatments for degenerative lumbar spinal stenosis.The aim of this study was to compare the clinical and imaging results of percutaneous transpedicular Lumbar interbody fusion（PE-TLIF）and minimally invasive transforaminal Lumbar interbody fusion（MIS-TLIF）for the treatment of single-level degenerative lumbar spinal stenosis,to explore a more minimally invasive and effective surgical method.MethodsThe clinical data of 57 patients with Single-segment degenerative lumbar spinal stenosis diseases who underwent minimally invasive lumbar decompression and fusion surgery in the First Affiliated Hospital of Zhengzhou University from July2018 to June 2020,28 males and 29 females;40-72 year old,with an average age of59.16;the distribution of responsible segments::L₃～L₄5 cases,L₄～L₅29cases,L₅～S₁23 cases.According to the surgical method,was divided into PE-TLIF group（26cases）and MIS-TLIF group（31 cases）,Among them,31 were in MIS-TLIF,including 14 male and 17 female;aged 40～71 years old,with an average age of58.32 years;the distribution of responsible segments:L₃～L₄3 cases,L₄～L₅14cases,L₅～S₁14 Cases.In the PE-TLIF group,26 patients,14 males and 12 females:aged40～72 years old,with an average age of 60.15 years;responsible segment L₃～L₄2cases,L₄～L₅15 cases,L₅～S₁9 cases.There were no significant differences in age,sex,physical index,surgical segment distribution,VAS pain score for lumbar and leg pain,and Oswestry dysfunction index（ODI）（P>0.05）.The operation time,intraoperative bleeding,postoperative drainage,postoperative hospital stay and complications were recorded and compared between the two groups.The improvement of Lumbar and lower limb pain was evaluated by visual analogue scale（Vas）at different time points before and after operation,and the improvement of function was evaluated by Odi index before and after operation The height of intervertebral space（DH）and the angle of segmental Lordosis（SL）were measured by x-ray and CT before operation and at the last follow-up.ResultsAll the patients underwent the operation successfully.In the MIS-TLIF Group,1case of Dura rupture occurred during the operation,there was no cerebrospinal fluid leakage after the corresponding treatment,such as hard membrane sealing,drainage,close suture of deep Fascia,and so on.In both groups,there were 1 case of short-term（5-14 days）post-operative numbness of the lower extremity on the decompression side,and the patients recovered completely after short-term dehydration and neurotrophic drug therapy.In the MIS-TLIF Group,there was 1case of superficial wound infection,which healed after anti-infection and debridement None of the patients had complications such as nerve root injury,epidural hematoma infection,postoperative lumbar instability or spondylolisthesis,there was no significant difference in the incidence of postoperative complications between PE-TLIF group（3.8%）and MIS-TLIF group（9.7%）（p=0.837）.The incision length,intraoperative blood loss and postoperative drainage in PE-TLIF group were significantly better than those in MIS-TLIF group（p<0.001）.The Vas score of PE-TLIF Group was significantly lower than that in MIS-TLIF group（p=0.011）.The scores of Vas and Odi of Lumbago and leg pain were significantly lower than those before operation（p<0.05）.At the last follow-up,DH and SL improved significantly（P<0.05）,but there was no significant difference between the two groups（P>0.05）.Twelve months after the operation,25 patients（96.15%）in the PE-TLIF group and 29 patients（93.45%）in the MIS-TLIF group achieved bony fusion.ConclusionIn the treatment of single-level degenerative lumbar Spinal Stenosis,as minimally invasive surgery,PE-TLIF and MIS-TLIF are both safe and effective in relieving the symptoms of Lumbago and leg pain,improving the function of limbs and improving the quality of life.In contrast,the PE-TLIF Group had a clearer field of vision,less surgical trauma and lower level of low back pain in the early postoperative period.less intraoperative bleeding,and less early postoperative low back pain,but the PE-TLIF group had smaller operating channels,so the procedure took longer.