Comparative Study Of Mid Approach MIS-PTLIF In The Treatment Of Lumbar Degenerative Diseases

Background and purpose:Degenerative lumbar spine disease is one of the most prevalent healthcare problems.Its symptoms usually have a structural origin,such as from a degenerated disc,facet joints,spinal instability,or sagittal malalignment.For treatment,it is necessary to decompress and fuse symptomatic segments.The conventional transforaminal lumbar interbody fusion(TLIF)technique has some disadvantages,including large surgical trauma,severe intraoperative blood loss,and paravertebral muscle injury,leading to low back pain in several patients after surgery.The minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)reported by Foley et al can significantly reduce intraoperative blood loss and soft tissue injury.However,most MIS-TLIF decompression approaches use a bilateral paramedian incision(Wiltse approach)through the space between the multifidus and longissimus muscle.Although it is highly convenient for exposing the intervertebral foramen and the side of lumbar vertebrae,it will inevitably cause difficulty during decompression surgery in the medial and central spinal canal owing to occlusion of the medial and upper joint processes to the nerve roots and dural sac.This occlusion denotes that the decompression procedure is complex,but the learning curve is smooth.In order to overcome the above shortcomings,we developed an improved MIS-TLIF(MIS-PTLIF)technology and aimed to determine whether it is effective in the treatment of degenerative lumbar diseases.Methods:A total of 120 patients with lumbar degenerative diseases treated in the First Affiliated Hospital of Nanchang University from October 2019 to March 2021 were retrospectively analyzed.They were randomly divided into ABC 3 group according to different surgical approaches.Patients in group a underwent modified MISTLIF surgery,patients in group B underwent MISTLIF surgery and patients in group C underwent TLIF surgery.Collect the age,sex and diagnosis of patients;The amount of intraoperative bleeding,operation time,postoperative complications and other clinical data were recorded,and the prognosis was evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI)questionnaire 3 and 6 months after operation.Statistical analyses were performed using SPSS software(version 23.0;SPSS Inc.).One-way analysis of variance was used to analyze continuous variables in each group,such as intraoperative blood loss and incision length.A chi-square test was used to analyze categorical variables,such as patient sex and number of operative segments.The least significant difference test was used to compare groups.A nonparametric test was used for data with nonhomogeneous variance,and P<0.05 was considered statistically significant.Results:The MIS-PTLIF group showed a significantly lesser bleeding amount(134.3±48.7 m L),smaller incision(5.2±1.2 cm),shorter hospital stay(4.0±0.7 days),and lower incidence of complications(2.9%)than those of the TLIF groups.However,no significant difference was noted in the operation time,bleeding amount,and hospital stay of the MIS-PTLIF and MIS-TLIF groups.Further,the MIS-PTLIF group showed significant differences in the incision length and complication rate compared with those of the MIS-TLIF group.Conclusions:MIS-PTLIF resulted in slight surgical trauma and intraoperative blood loss,with acceptable postoperative complications.Thus,it is effective and safe for the treatment of degenerative lumbar spine diseases.