Comperative Study Between Endo-TLIF And MIS-TLIF For The Treatment Of Single Segment Degenerative Lumbar Spondylolisthesis

Objective: Purpose: Comparison of Endoscopic transforaminal lumbar interbody fusion,meanwhile transforaminal interbody Fusion,Endo-TLIF)and Minimally invasive surgery transforaminal interbody fusion,minimally invasive surgery transforaminal interbody Fusion,The early clinical efficacy of two minimally invasive spinal operations in the treatment of single-level Degenerative spondylolisthesis(DLS),and the advantages and disadvantages of Endo-TLIF technology relative to MIS-TLIF technology were analyzed.Methods: The clinical data of 36 patients diagnosed with single-level degenerative lumbar spondylolisthesis(Meyerding classification Ⅰ ～ Ⅱ°)who received surgical treatment in the 2nd Department of Orthopaedics,Gansu Provincial People’s Hospital from October 2019 to April 2021 were retrospectively analyzed.The subjects were divided into endoscopic group and channel group according to the surgical method.A total of 18 patients were included in the endoscopic group,including 8 males and 10 females,aged(63.44±7.63)years,duration of disease(42.72±19.54)months,according to the Meyerding degree : including 3 cases of L3～4,11 cases of L4～5,and 4 cases of L5～S1 in the segment of spondylolisthesis.According to the Meyerding classification : There were 12 cases of I° and 6 cases of II°,Preoperative VAS score for lower back pain was(6.39±0.98),VAS score for lower extremity pain was(5.72±0.67),ODI score was(55.05±8.85)%,vertebral space height was(6.72±0.77)mm,CK value was(90.17±18.31)U/L.A total of 18 patients were included in the channel group,including 7males and 11 females.The age was(60.50±7.58)years and the course of disease was(40.67±26.08)months.There were L2～3 1 case,L3～4 4 cases,L4～5 10 cases,and L5～S1 3 cases in the segment of spondylolisthesis.According to the Meyerding classification,there were 14 cases of degree I°and 4 cases of degree II°.Preoperative VAS score for low back pain(6.33±1.03),postoperative VAS score for lower extremity pain(5.39±0.92),preoperative ODI score(53.75±8.85)%,preoperative vertebral space height Endo-TLIF MIS-TLIF(6.83±0.60)mm;Perioperative observation indexes(operation time,intraoperative fluoroscopy times,intraoperative blood loss,postoperative drainage volume,postoperative bed time,dosage of analgesics,length of hospital stay and postoperative complications,etc.),laboratory data(preoperative/post-operative serum creatine kinase(CK)),evaluation indexes of surgical efficacy(VAS score for lower back pain,VAS score for lower extremity pain,ODI index),space height and interbody fusion and other indexes were compared and analyzed in the two groups.Results: Operation time(176.11±27.15)mins and intraoperative fluoroscopy times(51.39±6.18)in endoscopic group were higher than those in channel group,and the difference was statistically significant(P<0.05).Intraoperative blood loss(105.00±54.36)ml,postoperative drainage volume(54.72±26.57)ml,dosage of analgesic drugs(124.50±48.27)mg,postoperative bed time(22.50±4.26)h and hospital stay(6.50±1.25)d were all lower in the endoscopic group than in the channel group.The difference was statistically significant(P<0.05).There was no significant difference in preoperative ODI score and VAS score between the two groups(P>0.05),ODI scores and VAS scores of both groups were significantly improved after surgery(P>0.05),the VAS score of endoscopic group was lower than that of channel group at 1 week(3.11±0.69)and 3 months(1.94±0.54)after surgery(P<0.05).The lower extremity pain VAS score of endoscopy group was lower than that of channel group(2.50±0.51)at 1 week after surgery(P<0.05),and there was no significant difference between the two groups at 3months and the last follow-up(P>0.05).There was no significant difference between the two groups at 3 months and the last follow-up(P>0.05).The ODI score of endoscope group(24.90±2.79)% was significantly lower than that of channel group at 3 months after surgery(P<0.05),and there was no significant difference between the two groups at the last follow-up(P>0.05).According to the Mac Nab standard at the last follow-up,in the endoscopic group,12 cases were excellent,5 cases were good,and 1 case was fair,with an excellent and good rate(94.44%).Channel group: excellent 10 cases,good 6 cases,fair 2 cases,excellent and good rate(88.89%),there was no Endo-TLIF MIS-TLIF statistical significance between groups(P>0.05).The CK value in the endoscopic group(371.08±73.39)U/L was lower than that in the channel group(439.13±107.63)U/L,and the difference was statistically significant(P<0.05).At the last follow-up,according to the Brantigan-Steffee interbody fusion criteria,both groups of patients had successfully achieved fusion,and there was no significant difference between the endoscopic group(16 cases of grade E and 2 cases of grade D)and the channel group(17 cases of grade E and 1 case of grade D)(P>0.05).In the endoscopic group,1 patient had leg numbness after surgery.Considering intraoperative nerve root stimulation or injury,the symptoms were gradually relieved after symptomatic treatment and disappeared 2 weeks later.In the channel group,the wound healing was delayed due to incision exudation,and the wound healed after frequent dressing change.Conclusions: Compared with MIS-TLIF surgery under expandable channels,Endo-TLIF surgery using visualization system has certain advantages in terms of intraoperative blood loss,postoperative bed length,hospital stay,and dosage of analgesic drugs.Endo-TLIF is a safe,minimally invasive and effective surgical procedure that has demonstrated satisfactory clinical efficacy and is an effective treatment for single level degenerative spondylolisthesis.