| Objective:The aim of this study was to evaluate the clinical efficacy and radiological outcomes of a minimally invasive transvertebral foraminal lumbar fusion with unilateral approach and bilateral decompression approach in patients with Schizas D extreme lumbar spinal stenosis and to assess its effectiveness and safety.Method:We enrolled patients diagnosed with lumbar 4-5 spinal stenosis at our institution from December 2018 to December 2020 who underwent minimally invasive transforaminal lumbar interbody fusion.Clinical outcomes were evaluated using visual analogue scores(VAS),Japanese orthopaedic association(JOA)scores,and Oswestry disability index(ODI)scores.The degree of lumbar spinal stenosis was graded according to Schizas’ grading criteria,and the axial canal diameter(CD),contralateral side spinal canal area(CSCA),central canal area(CCA),bilateral intervertebral foramen height(IFH)and area(IFA)were measured on MRI.The anterior disk height(ADH),posterior disk height(PDH),segmental lordosis(SL),and lumbar lordosis(LL)were measured on X-ray.Correlation coefficients were used to quantify the association between changes in lumbar sagittal segment parameters and changes in central canal and intervertebral foraminal dimensional imaging outcomes.Result:1.Comparison of preoperative baseline data: There were no statistically significant differences between the groups in terms of gender,age,BMI,preoperative back pain VAS,preoperative leg pain VAS score,preoperative JOA score,and preoperative ODI score(all P>0.05),which were comparable.2.Comparison of postoperative clinical outcomes among groups: all patients were followed up retrospectively for 2 years.Patients of all grades showed significant improvements in JOA,ODI and VAS scores of the back and legs at 6-,12-and24-month postoperative follow-up(all P<0.05).3.Comparison of clinical improvement outcome data between group:The degree of improvement in clinical outcomes before and after surgery was compared between groups: there was no significant difference in the degree of improvement in VAS scores,JOA scores and ODI scores for back and leg pain in Group D patients in other groups(all P>0.05).4.Comparison of pre-and post-surgical imaging outcome data between groups:A total of 72 patients with lumbar 4-5 segmental spinal stenosis were included in this study,including 9 grade A segments,10 grade B segments,28 grade C segments,and25 grade D segments.Postoperatively,the patients had grade A dural sac morphology in 43 cases,grade B in 28 cases,grade C in 1 case,and no grade D.Overall,CCA,CSCA and bilateral IFA,in all groups,were significantly higher than preoperatively,and the differences were statistically significant(all P<0.05).The preoperative and postoperative changes in bilateral IFH were not significantly different(all P>0.05),but patients in group D had elevated IFH,and the differences were statistically significant(P<0.05).In addition,ADH,PDH,SL and LL were significantly improved in all groups compared with preoperative(all P<0.05).Moreover,in the correlation analysis between changes in lumbar sagittal segmental parameters and changes in central canal and intervertebral foramen dimensions imaging outcomes in Group D patients,there was no meaningful correlation between the corresponding changes in each disc height,segmental pronation and lumbar pronation and changes in central canal dimensions or intervertebral foramen dimensions(P>0.05)5.Comparison of imaging improvement in each group: regarding the imaging changes in patients in group D,the amount of change in CD,CCA and CSCA was significantly greater than in grades A,B and C(P<0.05).As for the mean changes in bilateral IFH and IFA,there was no significant difference between grade D and the other grades(P>0.05).Interestingly,the mean change values and rates of change in CD,CCA and CSCA increased consistently from grade A to grade D.Regarding the mean changes in ADH,PDH,SL and LL,there was no significant difference between grade D and other grades(all P>0.05).6.perioperative patient data: there was no statistically significant difference between grade D patients and other grades in terms of operative time,intraoperative bleeding,postoperative drainage,duration of postoperative indwelling drains,postoperative hospital stay,and postoperative adverse effects or complications(all P>0.05).Conclusion:1.Minimally invasive transforaminal lumbar interbody fusion can achieve unilateral access for full spinal canal range decompression,significant imaging decompression in patients with Schizas grade D spinal stenosis,and satisfactory postoperative outcomes for patients with Schizas grade D lumbar spinal stenosis.2.Minimally invasive transforaminal lumbar interbody fusion for the treatment of patients with Schizas grade D lumbar spinal stenosis is safe and reliable and does not increase the risk of postoperative adverse events or complications compared with other levels of Schizas spinal stenosis in patients. |
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