Comparative Study On PLIF Operation And Modified Interbody Fusion Under Electronic Endoscopy In The Treatment Of Single-Segment Degenerative Lumbar Spondylolisthesis

BackgroundThe word spondylolisthesis comes from the Greek word "olistha nein" meaning slip,which broadly refers to the translation of one vertebral body over another,resulting in the instability of the vertebral segment.This leads to the original definition of lumbar spondylolisthesis,which is the forward,backward,or lateral displacement of all or part of a lumbar vertebra with respect to the lower stable vertebra.The most common type is degenerative Lumbar spondylolisthesis(DLS);which mainly affects middle-aged and elderly people.At present,there are still controversies about the classification and treatment of lumbar spondylolisthesis,but it is generally believed that conservative treatment is mainly used for patients with mild or early spondylolisthesis,and surgical treatment can achieve better clinical results for patients with severe or ineffective conservative treatment.Lumbar spondylolisthesis,especially degenerative lumbar spondylolisthesis(DLS),is often associated with lumbar spondylolisthesis,lumbar spinal stenosis,lumbar disc herniation and other lumbar diseases due to long-term instability of the lumbar spine,resulting in degenerative changes of intervertebral discs and facet joints.Under the function of these factors,the symptoms of lumbar olisthe performance also is varied,the symptom of lumbar instability degeneration caused by low back pain,there are also caused by stenosis of neurogenic claudication,and because of the intervertebral disc herniation oppression lateral crypt or intervertebral foramen of nerve root cause within the typical root of lower limb pain,all of these brought lasting pain to patients.The surgical treatment of lumbar spondylolisthesis has a long history.The posterior lumbar interbody fusion(PLIF)proposed by Briggs and Milligan in 1944 is a mature classic procedure.In this procedure,posterior spinal canal decompression,reduction of the slipped vertebral body,bone graft fusion,and screw fixation were performed simultaneously,which had good clinical effect.However,with the development of research,we also found that this surgical method has disadvantages such as greater trauma and more complications due to the extensive dissection of muscles and partial resection of the posterior column structure of the spine.With the rapid development of minimally invasive surgical techniques,it is a challenge and obligation for orthopaedic surgeons to explore new minimally invasive techniques for the treatment of lumbar spondylolisthesis.When it comes to the development of minimally invasive technology is inseparable from the application of endoscopic technique,the treatment group in the long-term clinical practice,the flexibility of using electronic endoscope,on the basis of traditional PLIF surgical,original a kind of new electronic endoscopic improvement between posterior lumbar fusion,in the treatment of lumbar olisthe reliable clinical results have been achieved,and achieve the purpose of minimally invasive.The report is as follows.ObjectiveTo compare the efficacy of traditional open posterior lumbar interbody fusion(PLIF)and electronic endoscopy modified interbody fusion for single-segment lumbar spondylolisthesis.MethodsA total of 64 patients who met the inclusion criteria for surgical treatment in our hospital from December 2019 to December 2020 were retrospectively analyzed,including 32 patients who were treated with open posterior lumbar interbody fusion(PLIF group)and 32 patients who were treated with modified electronic endoscopic interbody fusion(endoscopic group).Gender,age,sliding segment,Meyerding grading,course of disease,and preoperative visual analogue scale of pain in 2 groups VAS,Oswestry disability Index(ODI),slip Angle(SA),disc height(DH),lumbar lordosis,LL),and there was no significant difference(P>0.05).Perioperative general conditions,including intraoperative blood loss,operative time,incision length,postoperative bed time and postoperative short-term complications,were compared between the two groups.VAS scores and ODI scores were collected and compared between the two groups before surgery,7 days after surgery,3 months after surgery and at the last follow-up for clinical efficacy analysis.SA,DH and LL values were measured and compared between the two groups before surgery and 3 months after surgery,and the improvement of imaging indicators was analyzed.CT examination was performed at the last follow-up,and fusion was measured by Suk method.ResultsCompared with the PLIF group,the amount of intraoperative blood loss,incision length and postoperative bed time in the endoscopic group were significantly reduced(P<0.05),and the difference in operative time was not statistically significant(P>0.05).Postoperative fat liquefaction and cerebrospinal fluid fistula occurred in 1 case in the PLIF group,and transient pain aggravation of lower limbs occurred in 1 case in the endoscopic group.There was no significant difference in the incidence of perioperative complications(P>0.05).Patients in both groups were followed up for 6-12 months with an average follow-up of 8.7 months.VAS score and ODI score at each time point after surgery were significantly improved compared with those before surgery(P<0.05).Compared with the PLIF group,the VAS score and ODI score of the endoscopy group were lower at 7 days and 3 months after surgery,with statistically significant differences(P<0.05),and there was no statistically significant difference between the two groups at the last follow-up(P>0.05).Three months after surgery,SA,DH and LL in both groups were significantly improved compared with those before surgery,with statistical significance(P<0.05),but there was no statistical significance between the two groups(P>0.05).There was no significant difference in the fusion rate between the two groups at one follow-up(P>0.05).ConclusionBoth open PLIF operation and improved interbody fusion under new electronic endoscopy have achieved good efficacy in the treatment of single-segment lumbar spondylolisthesis,while the improved new operation under electronic endoscopy can effectively reduce intraoperative blood loss,incision length,postoperative bed time,relieve short-term postoperative pain,and accelerate postoperative functional recovery.