| Objective:To evaluate the early clinical efficacy of non-fusion techniques with IntraSPINE hybrid operation with TLIF in the treatment of double-segment LDD.Methods:A retrospective analysis of the clinical data of 74 patients with double-segment LDD from September2019 to May 2021 who were treated by non-fusion techniques with IntraSPINE hybrid operation with TLIF and TLIF in our hospital.74 patients were divided into observation group(non-fusion techniques with IntraSPINE hybrid operation with TLIF)and control group(TLIF).36 cases in the observation group;38cases in the control group.There were 20 males and 16 females in observation group(aged 49.08±5.28 years),and 23 males and 15 females in control group(aged 50.97±5.69 years).The follow-up period in observation group and control group were respectively 25.44±5.46 months and 25.84±4.23 months.There were no statistical differences in gender,age or follow-up period between the two groups(P>0.05).The visual analogue scale(VAS)of back and leg pain,Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI)were recorded before surgery,at 3 months and 6 months after surgery,and final follow-up.At the same time,lumbar lordosis(LL),range of motion(ROM),and height of intervertebral space of the upper adjacent segment of fusion segment were measured on lateral lumbar X-ray films.And Pfirrmann grade of intervertebral disc of the upper adjacent segment of fusion segment on lumbar MRI were recorded before surgery and at final follow-up.The complications during the follow-up of the two groups of patients were recorded.Results:The operative time,intraoperative blood loss and length of hospitalization in observation group and control group were respectively(153.89±26.86)min and(141.57±26.41)min,(211.67±54.59)ml and(190.53±59.77)ml,(11.08±2.1)d and(10.97±2.4)d.There were no statistical differences in operative time,intraoperative blood loss,or length of hospitalization between the two groups(P>0.05).At pre-operation,3months,6 months after surgery and final follow-up,the VAS scores of back pain were(7.17±1.06),(2.17±0.75),(1.72±0.83)and(1.33±0.89)respectively in observation group,and those were(7.03±0.92),(2.83±0.75),(2.14±0.82)and(1.87±0.81)respectively in control group;the VAS scores of leg pain were(6.32±1.28),(2.35±1.01),(1.43±0.65)and(1.28±0.68)respectively in observation group,and those were(6.45±1.25),(2.36±0.98),(1.49±0.78)and(1.34±0.84)respectively in control group;the ODI scores were(50.03±7.74)%,(19.13±4.79)%,(17.64±4.97)% and(14.76±5.21)% respectively in observation group,and those were(49.79±7.68)%,(19.17±5.01)%,(17.86±5.11)% and(15.09±5.02)% respectively in control group;the JOA scores were(12.03±1.58),(19.81±1.28),(21.86±1.69)and(25.86±1.62)respectively in observation group,and those were(12.05±1.52),(19.66±1.3),(21.95±1.41)and(25.68±1.56)respectively in control group;the LL were(35.75±7.48)°,(41.13±6.86)°,(41.31±6.84)° and(41.74±6.81)° respectively in observation group,and those were(34.02±7.46)°,(38.46±7.08)°,(38.66±7.07)° and(38.96±7.05)°respectively in control group;the intervertebral height of the upper adjacent segment of fusion segment were(9.57±1.38)mm,(11.03±0.87)mm,(10.87±0.84)mm and(10.72±0.83)mm respectively in observation group,and those were(9.55±1.32)mm,(9.41±1.29)mm,(9.22±1.26)mm and(8.93±1.21)mm respectively in control group;the ROM of the upper adjacent segment of fusion segment were(6.98±1.94)°,(6.29±1.9)°,(6.3±1.89)° and(6.41±1.9)° respectively in observation group,and those were(7.03±1.85)°,(7.14±1.84)°,(7.51±1.8)° and(8.52±1.81)° respectively in control group.The VAS scores of leg pain,JOA scores and ODI in both groups were significantly improved at 3 months,6 months after operation and final follow-up compared with those before surgery(P<0.05),with no statistical difference between groups at the same time point,respectively(P>0.05).The VAS scores of back pain in both groups were significantly improved compared with those before surgery(P<0.05),and those in observation group were more significantly improved than those in control group at 3 and 6 months postoperatively,and final follow-up(P<0.05).The LL of the two groups were significantly improved compared with the preoperative one(P<0.05),but there was no statistical difference between two groups at the same time point(P>0.05).At final follow-up,the ROM of the upper adjacent segment was not statistically different from that before operation in the fusion segment of observation group(P>0.05),while it was increased in control group compared with that before surgery(P<0.05);the intervertebral height of the upper adjacent segment of fusion segment was increased after operation in observation group(P<0.05),but that in control group was decreased compared with that before surgery(P<0.05).There were statistically significant differences in the Pfirrmann grade of intervertebral disc of the upper adjacent segment of the fusion segment at final follow-up between the two groups(P<0.05).During the follow-up,no patients in either group had serious complications,such as nerve root injury,dural tears,internal fixation system fracture,or displacement of the interbody device.Conclusion:IntraSPINE non-fusion technique combined with TLIF can achieve satisfactory early outcomes in the treatment of double-segment LDD,more significantly improve low back pain than TLIF,and delay ASD in early stage. |
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