Clinical Analysis Of MIS-TLIF And PLIF In The Treatment Of Two-level Degenerative Lumbar Spinal Stenosis

【Objective】To compare the clinical efficacy of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)with conventional posteriorlumbar interbody fusion(PLIF)for the treatment of degenerative two-segment lumbar spinal stenosis.fusion(PLIF)for the treatment of degenerative two-segment lumbar spinal stenosis.【Methods】Forty-two patients diagnosed with two-segment degenerative lumbar spinal stenosis and treated surgically in parallel at the Department of Spine Surgery,China-Japan Union Hospital of Jilin University from January 2018 to December 2020 were retrospectively analyzed.The patients were divided into two groups according to the surgical modality: 21 patients in the MIS-TLIF group,including 13(61.9)male patients and 8(38.1)female patients,aged 63.6±7.6 years,16(76.2)L3-L5 segments and 5(23.8)L4-S1 segments.21 patients in the PLIF group,including 10(47.6)male patients and 11(52.4)female patients.Female patients were 11(52.4),age 61.7±6.0years,12(57.1)in L3-L5 segment and 9(42.9)in L4-S1 segment.Age,gender,BMI,responsible segment,smoking,alcohol consumption,slippage score,operation time,intraoperative blood loss,incision length,postoperative drainage,bed rest time,and hospital stay were recorded.Patients in both groups were followed up for at least 6months.The preoperative and postoperative VAS(Visual Analogue Score)scores of low back pain at 3 days,January,March,and June and the preoperative and postoperative JOA scores(Japanese Orthopaedic Association Scores)of the lumbar spine at January,March,and June were recorded for comparative analysis,and the statistical software SPSS26.0 was used to analyze the data collected.The collected data were statistically analyzed using the statistical software SPSS26.0.【Results】1.The patients’ general data and admission characteristics data were balanced and comparable in terms of composition,and the composition ratios were not statistically different.2.The operative time of patients in the MIS-TLIF group was(194.29 ± 65.48)min,and that of the PLIF group was(156.05 ± 32.81)min;the incision length of patients in the MIS-TLIF group was(7.03 ± 0.40)cm in the MIS-TLIF group and(13.80±3.50)cm in the PLIF group;intraoperative bleeding in patients in the MISTLIF group was(260.00±58.22)ml and(370±106.58)ml in the PLIF group;postoperative drainage in the MIS-TLIF group(155.48±80.61)and in the PLIF group(559.05± 320.86);bed rest time for patients in the MIS-TLIF group was 3.0(3.0 3.0)d,and 5.0(4.0 5.5)d in the PLIF group;hospital stay for patients in the MIS-TLIF group was 8.0(7.0 10.5)d,and 14.0(10.5 16.5)d in the PLIF group;postoperative complication rate was 0(0.00)in the MIS-TLIF group and 1(4.80)in the PLIF group;the postoperative transfusion rate 2(9.50)in the MIS-TLIF group and 3(14.3)in the PLIF group.In the comparison between the two groups in the above data,the operative time was shorter in the PLIF group than in the MIS-TLIF group(P < 0.05),and the postoperative complications and postoperative transfusion rates were not statistically significant between the MIS-TLIF and PLIF groups(P < 0.05),but the rest were better in the MIS-TLIF group,and all of them were statistically different(P < 0.05).3.Within the two groups,the operative The difference between VAS scores before and 3 days after surgery,January,March and June was statistically significant(P < 0.05),and the VAS scores at 3 days after surgery between the two groups were slightly lower in the MIS-TLIF group than in the PLIF group(P < 0.05),and the difference between the MIS-TLIF group and the PLIF group at 1 month,March and June after surgery was not statistically significant(P > 0.05),indicating that in the short term after surgery The MIS-TLIF surgery was better than PLIF surgery in relieving patients’ pain symptoms.The differences in JOA scores between the two groups were statistically significant(P< 0.05)before and after surgery in January,March and June,and the differences in JOA scores between the two groups were slightly higher in the MIS-TLIF group than in the PLIF group in January and March(P < 0.05).In the short term after surgery,the MISTLIF procedure was better than the PLIF procedure in relieving patients’ pain symptoms.【Conclusion】Both PLIF and MIS-TLIF can effectively treat degenerative twosegment lumbar spinal stenosis and achieve a cure.In terms of intraoperative bleeding,surgical incision,postoperative drainage,postoperative bed rest,and postoperative hospital stay;and in terms of early postoperative lumbar pain and functional recovery,MIS-TLIF surgery has advantages,and in terms of operative time,MIS-TLIF surgery time is longer compared to PLIF,therefore,for patients with degenerative two-segment lumbar spinal stenosis,MIS-TLIF can Therefore,MIS-TLIF can be an effective procedure for patients with two-segment degenerative lumbar spinal stenosis.