The Clinical Effect Of Minimally Invasive Transforaminal Lumbar Interbody Fusion In The Treatment Of Single-level Grade Ⅱ Isthmic Spondylolisthesis

Objective To compare the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and traditional transforaminal lumbar interbody fusion(TLIF)in the treatment of single level II spondylolisthesis.Methods Data of patients with lumbar spondylolisthesis admitted to the Department of Spinal Surgery,Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2019 to December 2021 were collected.According to the inclusion and exclusion criteria,259 patients with single-level II spondylolisthesis were selected as subjects.131 of which received MIS-TLIF surgery,the remaining 128 patients received TLIF surgery,all of which were successfully completed and the patients received complete postoperative follow-up.The differences of operation duration,hospital stay,intraoperative blood loss and postoperative drainage volume between the two groups were compared.Imaging software was used to measure the pelvi-spinal sagittal position parameters of patients before and after surgery.The stability of lumbar sagittal position after surgery was compared between the two groups.Meanwhile,the reduction rate of slip,recovery of vertebral space collapse and interbody fusion rate were compared between the two groups.Visual analogue scale(VAS),modified Japanese orthopaedic association(M-JOA)oswestry disability index(ODI)and other indexes were recorded for each patient before and after surgery to compare postoperative sensory and behavioral function recovery between the two groups.As well as comparing the incidence of postoperative complications between the two groups.Results There were 50 male patients and 81 female patients in the MIS-TLIF operation group,with an average age of(53.2±6.8)years and an average course of disease of(18.12±6.31)months.There were 48 male patients and 80 female patients in the TLIF operation group,with an average age of(54.3±8.5)years and an average course of disease of(17.85±5.38)months.There were no differences in gender,age and course of disease between the two groups(all P > 0.05).In the MIS-TLIF group,the mean operation duration was(105.9±23.7)minutes,the intraoperative blood loss was(75.0±31.3)ml,the postoperative drainage volume was(77.5±58.6)ml,and the mean hospital stay was(5.5±1.3)days.In the TLIF group,the average operation duration was(102.1±33.0)minutes,the intraoperative blood loss was(94.1±45.8)ml,the postoperative drainage volume was(167.4±49.3)ml,and the average length of hospital stay was(7.1±1.8)days.Compared with the TLIF group,patients in the MIS-TLIF group had shorter average hospital days,less intraoperative blood loss and less postoperative drainage volume,and the differences were statistically significant(all P <0.05),but there was no significant difference in operation duration between the two groups(P > 0.05).Postoperative symptoms of lumbago and lower limb pain were effectively relieved and behavioral function was significantly improved in both groups.Compared with pre-operation,VAS score,ODI index and M-JOA score were significantly improved in both groups during postoperative follow-up at various time periods.lumbar lordosis(LL)and sacral slope(SS)degree increased postoperative in two groups,and the pelvic tilt(PT)and slip angle(SA)degree decreased.After the operation,pelvic retrogression was reduced and pelvic-spinal sagittal balance was restored.Both groups achieved satisfactory results in the reduction rate of slip,interbody fusion rate and the recovery of intervertebral space height.According to statistics,8 patients in the TLIF group had cerebrospinal fluid leakage after surgery,only 1 patient in the MIS-TLIF group had cerebrospinal fluid leakage,and 1 patient in each of the two operation groups had poor incision healing.Conclusions Both TLIF and MIS-TLIF can reduce the spondylolisthesis,fully decompress the nerves,reshape the pelvic-spinal stability,improve the symptoms of patients and improve the quality of life of patients.MIS-TLIF surgery has the advantages of less trauma and faster recovery,which is more in line with the modern clinical concept of rapid recovery.